Faster health insurance claim settlement via single-window platform NHCX begins;
how it will help policyholders
July 9, 2024
Synopsis
Health insurance rule change: The National Health Claims Exchange (NHCX) portal is set to simplify, accelerate, standardise the health insurance claim settlement process through the seamless exchange of information and documents between hospitals and insurance companies. For the the health insurance policyholders, the NHCX platform will speed up the claim settlement process so the waiting time to get discharged from the hospital will be reduced. What is going to change for health insurance policyholders?
The era of simplified, easy, more streamlined, and faster settlement of health insurance claims has started. HDFC Ergo said on Tuesday, July 9, 2024, that they have successfully processed its first claim through the National Health Claims Exchange (NHCX) platform. The insurer says, "This marks a significant leap forward, which will help streamline health claims processing, improve administrative efficiencies, and enhance customer experience by building a cohesive technology-driven system." What is the National Health Claims Exchange platform? How does it help health insurance policyholders? Read on to know more about NHCX platform and its benefits for health insurance policyholders.
What is the National Health Claims Exchange (NHCX)?
The National Health Claims Exchange or NHCX platform is a single-window digital platform developed by the National Health Authority (NHA) and the Union Ministry of Health and Family Welfare as part of the Ayushman Bharat Digital Mission. Think of it as a gateway for exchanging claims-related information among various players involved in the claim process including ‘payers’ (insurer, third-party administrator, government scheme administrator) and ‘providers’ (hospital, laboratories, polyclinics), beneficiaries and other relevant entities at one place.
How will the National Health Claims Exchange (NHCX) work?
The National Health Claims Exchange portal is set to simplify, accelerate and standardise the health insurance claim settlement process through the seamless exchange of information and documents between hospitals and insurance companies. Parthanil Ghosh, Director & Chief Business Officer, of HDFC ERGO General Insurance, says, "As the one-stop platform for exchanging claim-related information among different stakeholders in the healthcare ecosystem, the NHCX will empower individuals, medical services providers and insurers with greater access to healthcare data and thus will be instrumental in ensuring seamless claim experience."
He adds, "The National Health Claims Exchange platform will be a significant leap towards ensuring the interoperability of health claims, democratising insurance and fostering transparency within the industry."
Health insurance claim settlement through NHCX starts: What will change for health insurance policyholders?
While filing for cashless claims now the policyholder needs to submit a health insurance card along with relevant forms and documents to the hospital. Then the hospitals manually fill up claim forms, scan documents, and upload these to multiple portals of the insurance companies or third-party administrators. At the insurer’s end, the data is digitised, manually authenticated, and adjudicated. Then the insurer or TPA sends the documents back to the hospital to process the discharge of the insured.
With the introduction of NHCX, most of the processes will be digitised and automated. There will be a common claim format that will be used across government or private health insurers and hospitals defined by NHA. The hospitals can access digitised details of the insurer via his Ayushman Bharat Health Account (ABHA) number.
The NHCX portal will automatically validate the details before routing these to the specified insurer. The insurer will digitally verify and adjudicate it, and the hospital will process the discharge.
Faster health insurance claim settlement
Recently, the Insurance Regulatory and Development Authority of India (Irdai) has mandated that all cashless claims be processed within three hours of the receipt of a discharge authorisation request from the hospital. If there is any delay over three hours, the additional amount, if any, that is charged by the hospital shall be borne by the insurer from the shareholder’s fund.
Additionally, the insurer shall have to decide on the request for cashless authorisation within one hour of the receipt of the request, the regulator said.
For the health insurance policyholders, the NHCX platform will speed up the claim settlement process so the waiting time to get discharged from the hospital will be reduced. It will also expected to reduce claim processing costs for each claim processed by the insurance company, thus bringing down the operational cost of the insurer. As the system is more transparent, the frauds are also expected to reduce. Shashank Avadhani, Co-Founder & CEO, Alyve Health, says, "The launch of the National Health Claims Exchange (NHCX) will be a pivotal milestone for the health insurance industry in India. NHCX will replace the onerous and manual claims operations with seamless and secure health data transfer from healthcare providers to insurers. This will enable customer-centric insurers and health platforms to provide instant claim settlements and 100% transparency to customers. At a systemic level, NHCX will reduce fraud, ultimately reducing healthcare costs."
[The Economic Times]
