Launch Of The National Health Claim Exchange
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<div style="text-align: justify;"> </div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">The National Health Authority (NHA) and the Insurance Regulatory and Development Authority (IRDAI) in India collaborated to create the National Health Claim Exchange (NHCX), a digital platform for health claims. The Ayushman Bharat Digital Mission (ABDM) aims to enhance healthcare services throughout India. </span> </p><p> </p><h2><span style="font-size: 14pt;"><span xml:lang="EN-US" data-contrast="none">Overview of the Current Claim Processing</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></span></h2></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">Presently, patients who come to a hospital for care are given the insurance company's card or the information of their policy, whichever is issued by the Third Party Administrator (TPA). The State Health Agency (SHA) issues the card if it's part of the Pradhan Mantri Jan Arogya Yojana (PMJAY). The hospital then logs onto each payer's claim processing portal and uploads the necessary files to initiate the pre-authorization or claim approval process. It is just intended for a particular plan or program. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">The State Health Agency, the Insurance Company, or the Third Party Administrator (TPA) will use their internal claims processing system to validate and digitize the pre-authorization/claim form upon receipt. The relevant team will subsequently decide on the claims. While over 90% of claims are auto-adjudicated in many industrialized countries, a sizable component of the adjudication process in India is currently manual. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p> </p><h2><span style="font-size: 14pt;" xml:lang="EN-US" data-contrast="none">Challenges of the Current Process</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></h2></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">There is a lack of consistency in the present claim exchange mechanism throughout the ecosystem. The majority of data communication takes either manually or using PDF means. Furthermore, no recognized health standards exist. </span><span xml:lang="EN-US" data-contrast="none">The procedures used by TPAs, providers, and insurers differ greatly.</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">NHA, in collaboration with industry experts, has developed a standard domain definition and NHCX protocol to tackle these difficulties. The publication has been made available for industry participants, including insurance companies, TPAs, and state health agencies, to provide comments. The goal of this cooperative and open endeavor is to produce a set of open, broadly accepted Health Claims data Exchange Specifications that the general public can use for free. The public can now review the Cashless Claims Specifications, and NHA is willing to have discussions about them. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">Each component of the proposed claims network is outlined in the National Health Claims Exchange Specifications, which also provide for vendor and technology neutrality, flexibility in response to evolving requirements, and the encouragement of creativity and inclusivity. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p role="heading" aria-level="2"> </p><h2 role="heading" aria-level="2"><span style="font-size: 14pt;"><span xml:lang="EN-US" data-contrast="none"><span data-ccp-parastyle="heading 2">Key points about NHCX</span></span><span data-ccp-props="{"134233117":false,"134233118":false,"134245418":true,"134245529":true,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></span></h2></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Purpose and Functionality</span></strong><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">NHCX acts as a single point of contact between hospitals, policyholders, and health insurance providers. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">Its principal objective is to replace laborious manual methods with a standardized, digital system, thereby streamlining the health claim filing process. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">The platform serves as a conduit for information relating to claims to be shared between different players in the healthcare and insurance industry. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span style="font-size: 12pt;"><strong><span xml:lang="EN-US" data-contrast="none">Stakeholders Involved</span></strong></span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Health Insurance firms</span></strong><span xml:lang="EN-US" data-contrast="none">: NHCX offers a standardized platform for effectively processing and resolving claims for health insurance firms. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Hospitals and Service Provider</span></strong><span xml:lang="EN-US" data-contrast="none"><strong>s</strong>: To verify claims, hospitals can use NHCX to submit information about their treatments, costs, and other pertinent factors. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Policyholders</span></strong><span xml:lang="EN-US" data-contrast="none">: The streamlined procedure made possible by NHCX is advantageous to people wishing to file claims for health insurance. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p> </p><h2><span style="font-size: 14pt;" xml:lang="EN-US" data-contrast="none">Benefits of NHCX</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></h2></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Faster claim processing</span></strong><span xml:lang="EN-US" data-contrast="none">: NHCX is a single platform for insurers, hospitals, and other healthcare providers to share claim data securely. This eliminates the need for manual paperwork and facilitates faster claim approvals. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Improved Interoperability</span></strong><span xml:lang="EN-US" data-contrast="none">: The platform ensures seamless exchange of standardized health information across different healthcare systems. This reduces the chances of errors and delays due to data incompatibility. </span><span xml:lang="EN-US" data-contrast="none">Enhanced transparency</span><span xml:lang="EN-US" data-contrast="none">: NHCX promotes transparency in the claim settlement process. Policyholders can easily track the status of their claims and access relevant information. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><strong><span xml:lang="EN-US" data-contrast="none">Benefits for all stakeholders</span></strong><span xml:lang="EN-US" data-contrast="none">: NHCX is expected to benefit all parties involved by streamlining the process. Patients will experience quicker claim settlements, hospitals will receive faster reimbursements, and insurers can improve operational efficiency. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p> </p><h2><span style="font-size: 14pt;" xml:lang="EN-US" data-contrast="none">Current Challenges Addressed</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></h2></div><div style="text-align: justify;"><ul><li><span xml:lang="EN-US" data-contrast="none">Under the current procedure, hospitals receive patients' health plan details and use those details to start the claims process</span></li></ul></div><div style="text-align: justify;"><ul><li><span xml:lang="EN-US" data-contrast="none">Hospitals use the insurer's platform to enter treatment information, such as cost and length of stay</span></li></ul></div><div style="text-align: justify;"><ul><li><span xml:lang="EN-US" data-contrast="none">Based on diagnosis reports, the insurer confirms the claim and grants approval</span></li></ul></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">However, this procedure is cumbersome and time-consuming because it involves managing numerous businesses, patients, and portals. </span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">NCHX is believed to be accessible across India from the launch date, and sources said it will initially provide a connection between stakeholders of already-linked 50 insurance companies and 250 hospitals, with more hospitals and insurers to join in the future.</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div style="text-align: justify;"><p><span xml:lang="EN-US" data-contrast="none">Major players that have already finished integration with NHCX are:</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p><ul><li><span style="font-family: Verdana, sans-serif;">Aditya Birla Health Insurance Company Limited </span></li><li><span style="font-family: Verdana, sans-serif;">Star Health and Allied Insurance Co. Ltd </span></li><li><span style="font-family: Verdana, sans-serif;">Bajaj Allianz Life Insurance </span></li><li><span style="font-family: Verdana, sans-serif;">HDFC ERGO General Insurance </span></li><li><span style="font-family: Verdana, sans-serif;">ICICI Lombard General Insurance Company Limited </span></li><li><span style="font-family: Verdana, sans-serif;">New India Assurance </span></li><li><span style="font-family: Verdana, sans-serif;">TATA AIG General Insurance Company Limited </span></li><li><span style="font-family: Verdana, sans-serif;">United India Insurance Co. Ltd.</span></li></ul></div><div style="text-align: justify;"> </div><div style="text-align: justify;"><p> </p><p><span xml:lang="EN-US" data-contrast="none">NHCX is the next major reform in the insurance industry. IRDAI has earlier approved 'Bima Sugam' another revolution in the insurance sector to provide an online marketplace for insurance, to help policyholders compare premiums and features of all categories of insurance products. buy insurance products including life, health, motor and travel insurance.</span><span data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559738":0,"335559739":0,"335559740":279}"> </span></p></div><div><p style="text-align: justify;"><span data-ccp-props="{"201341983":0,"335559739":160,"335559740":279}"> </span></p><p style="text-align: justify;"> </p><p style="text-align: justify;"> </p></div>
KR Expert - Sujeet Katiyar
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