You Will Make Health Insurance Claims Via National Health Claims Exchange, Check Details Inside

New Delhi: Insurance companies, pay attention. Soon all health insurance claims will be processed by hospitals and insurance companies through a single window called the National Health Claims Exchange (NHCX). As per the Health Ministry, the NHCX, developed by the National Health Authority (NHA), is currently under trial and will have a standardised format to be followed by insurance companies to process claims.
At present, most of the insurance companies offering health coverage have their own platforms and processes to approve claims.
The patients who come to the hospital for treatment provide their insurance policy details or a card issued by the third-party administrator (TPA) or insurance company. Then the hospital accesses the claim processing portal of the company and uploads the required documents for pre-authorisation or claim approval. After receiving the pre-authorisation/claim form, the insurance company/TPA authenticates and digitises the form using its internal claims processing portal. After this, the claim is adjudicated by the relevant team.
A senior official at the Health Ministry said the process to make claim is so complicated that patients are often forced to wait for long hours to get approval and there were complaints about denial of claim on allegedly unjust grounds.
To address these issues, the Union Health Ministry is setting up a National Health Claim Exchange (NHCX) platform to simplify the process of filing health insurance claims.
The National Health Exchange platform will work as a communication between the payer and the service provider.
“This platform is developed by the National Health Authority (NHA) to ensure faster processing of insurance claims and interoperability,” official sources told ANI.
The Insurance Regulatory and Development Authority (IRDAI) also advised all insurers and service providers to onboard the NHCX. The portal is expected to be launched soon within two to three months.
“The National Health Claim Exchange portal is almost ready and likely to be launched in the next two to three months. This portal has been developed as part of Ayushman Bharat Digital Mission (ABDM),” said official sources.
The portal NHCX will be a single platform that will serve as a gateway for exchanging claims-related information between the payer and service providers.