The Union Health Ministry is set to launch the National Health Claim Exchange (NHCX) Portal in the next two to three months to revolutionize the settlement of health insurance claims. Developed under the National Health Authority (NHA), this digital platform aims to simplify the filing of health insurance claims, expedite processing times, and enhance interoperability among stakeholders, as reported by official sources on May 22, 2024.
Currently, the health insurance sector suffers from fragmented processes with each insurance company using separate portals, making claim settlements cumbersome and time-consuming for both hospitals and patients. The lack of standardized data exchange and the reliance on manual or PDF methods further add to the inefficiency and high costs.
To address these issues, the NHA and the Insurance Regulatory and Development Authority of India (IRDAI) have collaborated on the NHCX platform for over a year. IRDAI issued a circular in June 2023 instructing insurers to join NHCX. This new system will serve as a single-window interface for health insurance companies, hospitals, and policyholders, streamlining the claim processing with a unified portal. The NHCX will function as a gateway for exchanging claims-related information using FHIR-compliant e-claim formats and standard APIs, which will enhance transparency, efficiency, and reduce operational costs.
The NHCX is part of the Ayushman Bharat Digital Mission (ABDM), which aims to integrate various digital health solutions across hospitals nationwide. ABDM also focuses on digitalizing hospital processes and creating Ayushman Bharat Health Accounts (ABHA) for patients, with over 62.12 crore ABHA accounts already created as of May 24, 2024.
Initially, the NHCX will connect stakeholders from 50 insurance companies and 250 hospitals, with plans to expand further. Major insurers like Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance, and others have already integrated with NHCX.
Following IRDAI’s mandate for electronic issuance of insurance policies from April 1, the NHCX represents a significant step forward in the insurance industry. It follows the earlier approval of ‘Bima Sugam,’ an online marketplace for insurance products, helping policyholders compare and purchase various insurance plans, including life, health, motor, and travel insurance.
