Faster Health Insurance Claim Settlement Via Single-Window Platform NHCX Begins: How It Will Help Policyholders?

National Health Claims Exchange (NHCX) is expected to revolutionise the health insurance industry by simplifying, accelerating, and standardising the processes of settling claims for health insurance. This reform in health insurance will enhance the settlement process by facilitating seamless information and document exchange between hospitals and insurance companies. With this new platform, the waiting time for claim settlements will be reduced significantly thereby enabling faster discharges from hospitals. So, what are some changes that will occur after introducing a NHCX platform to health insurance policyholders?

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What is the National Health Claims Exchange (NHCX)?

The National Health Claims Exchange (NHCX) refers to a single-window digital platform developed by the National Health Authority (NHA) and the Union Ministry of Health & Family Welfare as part of the Ayushman Bharat Digital Mission. It is an interface through which insurers, third-party administrators (TPAs), government scheme administrators, hospitals, laboratories, polyclinics as well as beneficiaries can exchange information pertinent to claims.

How Will the National Health Claims Exchange (NHCX) Work?

The primary aim of the NHCX portal is to make it easier for hospitals and insurance companies to share information so that they can streamline their health insurance claim settlement processes. Bhaskar Banerjee, Chola MS General Insurance’s Executive Vice President of marketing, said: "In addition, NHCX would act like a hub where any participant in the healthcare ecosystem in India could connect with others seamlessly over data sharing".

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Health Insurance Claim Settlement Through NHCX: What Will Change for Policyholders?

At present, while processing cashless claims policyholders must present their health cards along with relevant forms and documents at the hospital facility. The hospital then manually fills up claim forms before scanning the documents and uploading them into various portals of different insurers or TPAs. This data is digitised on the insurer’s end leaving room for manual authentication and adjudication. Then again all these documents are sent back to the hospital by the insurer/TPA to have the insured patient discharged.

With the introduction of NHCX, most processes will be digitised and automated. This common claim format will prevail across both government and private health insurers as identified by NHA. ‘The Ayushman Bharat Health Account (ABHA)’ number enables hospitals to access digitised insurer details.

The information is automatically validated by the NHCX portal before reaching the specified insurer. The insurer will then, digitally, verify and adjudicate the claim while the hospital discharges him/her.

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Faster Health Insurance Claim Settlement

Recently, India's Insurance Regulatory and Development Authority (IRDAI) mandated that all cashless claims should be processed within three hours upon receipt of the request for discharge authorisation from the hospital. In case it exceeds 3 hours later any additional amount charged by the hospital shall be borne by the insurer out of the shareholder fund.

Similarly, “in case where such request is complete in all aspects, the decision shall be communicated to the service provider within one hour of receipt of such request,” said the regulator.

To health insurance policyholders, this NHCX platform guarantees a faster settlement process which adds up to a shorter time in the hospital before getting discharged. Additionally, given that there may be fewer claims being made against each claim leading to lower per-claim processing costs for an insurance company. Furthermore, since operations become more transparent, frauds are expected to go down as well.

According to Shashank Avadhani, Co-Founder & CEO of Alyve Health, the National Health Claims Exchange (NHCX) launch will be a defining moment for India’s health insurance industry. NHCX will replace the tiresome and manual claim operations with smooth data transfer systems that are safe between providers and insurers. This would enable insurers offering customer-centric health platforms to settle claims instantly and offer total transparency to clients. On a larger scale, NHCX will curb fraud thereby decreasing healthcare expenditure.

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Benefits of the National Health Claims Exchange

• Streamlined Process: The NHCX platform standardizes the claim settlement process making it simple for policyholders and insurers alike.

• Faster Settlements: With faster processing times, patients are discharged from hospitals more quickly.

• Cost Cutting: Automation and digitization have led to lower operational costs for insurance companies.

• Openness: Enhanced transparency mitigates risks of fraudulence guaranteeing an equitable settlement process.

• Interoperability: Facilitate seamless information exchange among different stakeholders in the healthcare ecosystem.

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Conclusion

The introduction of the National Health Claims Exchange (NHCX) is a significant step forward in terms of fast, transparent and efficient claim settlements in the health insurance sector. Besides speeding up the claim process for policyholders, this platform can help cut costs for insurers as well as improve service quality. Once this new system has been adopted by the industry, it is expected that there will be a radical shift towards efficient handling of health insurance claims in India.

To know more and understand how the NHCX platform can benefit you, please click here.