All health insurance claims will be processed by hospitals and insurance companies through a single window – the National Health Claims Exchange (NHCX) soon.
Health ministry sources said that NHCX, developed by the National Health Authority (NHA), is ready and undergoing trials. It will have a standardised format to be followed by insurance companies to process claims. At present, insurance companies have their own platforms and processes to approve health claims.
The current process involves patients providing their insurance policy details, or a card issued by the third-party administrator (TPA) or insurance company, to the hospital.
The hospital then accesses the claim processing portal of the company and uploads the required documents for pre-authorisation or claim approval. The subsequent process is complicated, time-consuming and has the risk of potential errors.
Joint effort
The NHCX platform has been developed by NHA, the apex body responsible for implementing the Ayushman Bharat PM Jan Aarogya Yojana, and the Insurance Regulatory and Development Authority (IRDAI).
While IRDAI will continue to regulate the insurance industry, the motive for establishing NHCX is to facilitate faster and more transparent processing of health insurance claims, said sources in the health ministry.
Patients are often forced to wait for long hours to get approval. Also, there are frequent complaints about denial of claim on unjust grounds.
The Ayushman Bharat Digital Mission provides digital health IDs (ABHA IDs) for all Indian citizens. The NHCX platforms will use ABHA IDs to access patient information for clearing insurance claims.
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