National Health Claim Exchange (NHCX)

National Health Claim Exchange (NHCX) Latest News

A sub-committee on health insurance headed by Insurance Regulatory and Development Authority of India (IRDAI) Chairman considered measures that will encourage insurers and hospitals to join the National Health Claims Exchange (NHCX). 

About National Health Claim Exchange (NHCX)

• It is developed under the Ayushman Bharat Digital Mission (ABDM).
• It is developed by the National Health Authority (NHA) in consultation with the Insurance Regulatory and Development Authority of India (IRDAI).
• It the 
• NHCX serves as a gateway for exchanging health claim information among insurers, third-party auditors, healthcare providers, beneficiaries, and other relevant entities.
• Purpose: To streamline and standardize the processing of health insurance claims across the country, leveraging the Fast Healthcare Interoperability Resources (FHIR) standards to ensure interoperability across diverse systems.

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Features of National Health Claim Exchange (NHCX)

• Checking Coverage Eligibility: Providers can verify if a treatment is covered by insurance to avoid unexpected costs.
• Pre-Auth Request Submission: Hospitals can request approval from insurers before starting treatment.
• Predetermination Request Submission: Providers can ask for an estimate of benefits for a treatment before it begins.
• Claim Submission: Hospitals submit claims in a standard format for easier processing by insurers.
• Payment Status: Hospitals can check the payment status of submitted claims, ensuring everyone stays informed.
• Communication Request: Providers can send questions or requests for more information through NHCX.
• Reprocess Request: If a claim has issues, providers can request a review for a solution.

Source: TH