National Health Claims Exchange- Government One-Stop Portal For Insurance Claims

Are you tired of the long waiting period involved with handling health insurance claims? Then this article is just right for you. The Indian Government is set to launch and revolutionise the process of claims with the introduction of the National Health Claims Exchange (NHCX). This innovative, one-stop portal is designed to make hospital insurance claims processing a simple and easy task. They are working collaboratively with major organisations to cut down the complexities and frustrations that come along with claim processing for both hospitals and patients. 

Read this article to learn more about how the Government is getting ready to provide a more efficient and smoother healthcare experience for all of you. 

What Is National Health Claims Exchange (NHCX)?

The National Health Claims Exchange (NHCX) is a digital platform set up by the Indian government to make dealing with health insurance claim processing a lot easier and hassle-free. It is jointly developed by the National Health Authority (NHA) and the Union Ministry of Health and Family Welfare as part of the Ayushman Bharat Digital Mission. It is being created on the recommendation of the joint working group of some of the important groups related to insurance and health services in India, such as the Insurance Regulatory and Development Authority of India (IRDAI) and NHA. 

The goal is to transform the healthcare landscape by ensuring seamless communication and information exchange between hospitals, insurance companies, and patients and to promote the use of this single platform among them. This way, hospitals won’t have to deal with different processes related to the company's different systems, which can make things a lot simpler and reduce paperwork. The aim is to make things clearer and faster for everyone, reducing the chance of mistakes or fraud. Hence, IRDAI has urged everyone to join in the mission. 

How Will NHCX Work?

The NHCX will be operating on a standard format and will be using a common data collection method with all the necessary required information, ensuring that all health insurance companies understand and process the information provided on the portal. This will result in minimal manual intervention and data cleaning, leading to faster approvals and claim settlements.

Nearly 50 insurance companies and 200 large hospitals throughout the country will be utilising the portal. Insurance companies will not be mandated to use this portal. It was developed after the consensus recommendation from IRDAI, hospitals, and various insurance providers. The Government's goal is to develop digital health records for everyone, and this will assist in constructing that technical system. It also aims to speed up the pre-authorisation time and discharge approvals, ultimately affecting insurer companies' premiums and CSR ratio. 

Pilots of this project are already underway, and a full-fledged launch is part of the 100-day plan drawn to by the current government.

Benefits Of National Health Claims Exchange

NHCX will not only shorten the claim processing time but will also improve transparency and reduce manual errors to the greatest extent. Let’s look at more detailed benefits it will bring to enhance policyholder’s experience:

• Faster Claim Process: The central system will improve claim processing and approvals. It will make the process faster and reimbursements quicker for hospitals, thereby improving the cash flow. 

• Reduced Administrative Work: Hospitals would not need to manage multiple portals and data formats that come with various insurers onboarded. They will have a standard platform for simplified claim processing, leading to reduced paperwork.

• Increased Transparency: It will provide real-time visibility into the claim status for tracking for all stakeholders. It will help in building more accountability and enhanced transparency. 

• Reduced Fraud: The standard process in the central platform, which is in common data formats for everyone, will make it easier to detect fraudulent claims. It will also lead to the protection of both hospitals and insurance companies, making it a win-win situation. 

Let’s look at the benefits from a wider perspective for hospitals, insurance companies, and patients. 

Goals Of 100 Day Plan

With the 100-day plan already drawn up by the Union Health Ministry, the Government is targeting three key areas of the health industry. The first is the NHCX, which we have already discussed in detail.

The second objective is to launch eVin, the Government's vaccine management platform. This portal is aligned with the objectives of Co-WIN, which was used mainly during the COVID-19 vaccination drive. The purpose of electronic vital records (eVIN) is to keep track of a child's birth information as well as their vaccination history so that they can get their certificate online whenever they need it. In order to centralise children's health parameters on one platform, the system will be integrated with Anganwadi and schools with the help of ABHA, a digital health account. The tentative launch of eVin is expected by September. 

The third aspect of this plan is to station BHISM cubes at all the AIIMS and major central Government hospitals, such as PGI Chandigarh and JIPMER Puducherry. The BHISM cube is a portable medical health and operation theatre meant to be used during health emergencies such as disasters or any other unforeseen circumstances. The above-mentioned hospitals already have trained manpower, so it will be easier to deploy the cubes in situations of emergency with greater efficiency.

Conclusion

NHCX is a prominent step towards simplifying the complexities of the healthcare industry and insurance claims in India. It promises to bring benefits to all its stakeholders, such as hospitals, insurance providers, and patients, by making the system more user-friendly, efficient and transparent. 

The NHCX is still being processed, and we can expect its launch in the near future. We will continue to monitor its progress and provide regular updates on its implementation. For more insurance-related updates, keep visiting InsuranceDekho.