In collaboration with the IRDAI, the NHA aims to operationalise the NHCX, serving as a gateway for exchanging claims-related information within the healthcare and health insurance ecosystem.
Ten hospitals have recently joined the National Health Claim Exchange (NHCX), a digital health claims platform following an accelerator workshop conducted by the National Health Authority (NHA).
In collaboration with the Insurance Regulatory and Development Authority of India (IRDAI), the NHA aims to operationalise the NHCX, serving as a gateway for exchanging claims-related information within the healthcare and health insurance ecosystem.
The participating hospitals that successfully joined the NHCX provider registry include Jupiter Hospital (Thane), Kauvery Hospitals (Chennai), A J Hospital Research and Research Centre (Bengaluru), Sarvodaya Hospital (Faridabad), Fortis Hospital (Gurugram and Noida), Shri Balaji Action Hospital (Delhi), Sanar International Hospital (Gurugram), Centre for Sight (Dwarka, Delhi), and Narayana Hrudayalaya (Delhi).
Additionally, the hospital/claim management systems (HMIS) of these hospitals were able to complete the requisite M1 integration of Ayushman Bharat Digital Mission (ABDM), an essential step for NHCX integration. The M1 integration enables the creation and verification of Ayushman Bharat Health Account (ABHA).
The workshop also marked the completion of full integration with NHCX by eight insurance companies/TPAs, bringing the total count to 12 insurance companies successfully integrated with NHCX.
Notably, four insurance companies, namely Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance Company, and HDFC Ergo Insurance, had already completed full integration in the second workshop held in October.
NHA and IRDAI have been actively organising workshops to facilitate collaboration between insurance companies, TPAs, and hospitals. The third workshop, with over 150 professionals representing 45 organisations, showcased significant progress. Organisations were encouraged to select their most popular retail product along with one network hospital to pilot the operationalisation of NHCX.
How DHIS is Helping NHCX
In a bid to promote digital health transactions and the digitisation of patient health records, NHA has introduced financial incentives under the Digital Health Incentive Scheme (DHIS), effective from January 2023.
As part of DHIS, to encourage efficiency in insurance claim processing, hospitals will receive financial incentives of INR 500 per claim or 10% of the claim amount, whichever is lower, for every insurance claim transaction processed through NHCX. This initiative aims to drive the adoption of digital health practices nationwide.
During the workshop, seven insurance companies and one Third-Party Administrator (TPA), including names such as ICICI Lombard General Insurance, The New India Assurance Company, Tata AIG General Insurance Company, and United India Insurance Company, also completed the integration process with NHCX.
The platform's integration is expected to streamline health claims processing, enhancing efficiency and transparency in the insurance industry ultimately benefiting policyholders and patients.
With a circular issued in June 2023, the IRDAI urged all insurers and providers to onboard the NHCX, paving the way for seamless interoperability of health claims processing.
The collaboration between hospitals and insurers is expected to lead to improved efficiency, reducing processing times and enhancing the overall experience for both healthcare providers and insurance companies.
Anticipating a full-scale launch soon, the NHA highlighted the enthusiastic participation of insurance companies and providers during the three-day workshop held from November 7 to 9 in New Delhi. The workshop aimed primarily at onboarding hospital providers to NHCX and ensuring full integration with insurance companies.
Ten hospitals participated in the workshop, each paired with an insurance company. Technical and business teams from these hospitals were guided by teams from NHA, IRDAI, and NRCeS (National Resource Centre for EHR Standards) to facilitate onboarding to NHCX.