33 major health insurers now on national claims exchange – Times of India

NEW DELHI: At least 33 major companies offering health insurance in India have joined the NHCX or National Health Claims Exchange – a centralised platform developed by govt for exchange of insurance claims related information.
Till now, this exchange takes place via multiple platforms which leads to increased processing time. NHCX use, govt sources said, will not only expedite the insurance claims process but it will also make the whole process transparent as Insurance Regulatory Development Authority of India (IRDAI), the top insurance regulatory body of the country, will have access to the claims settlement status in real time.
“Citizens will also be able to see the status of their insurance claim through the mobile,” said a top official of the National Health Authority (NHA), which has developed the centralised platform. He said that some companies have already started processing claims via the NHCX on a trial basis and an official launch of the platform along with all features will be done soon.
Recently, HDFC Ergo, a major player in the health insurance industry, reportedly processed its first claim through NHCX which has been developed by the NHA in collaboration with IRDAI.
Sources said the NHCX, in its current form, does not intend to regulate the business, but records generated from the digital platform can certainly be used in future to devise systems to be added to the platform to prevent malpractices such as refusal to accept a claim on unjust grounds.
Currently, patients who visit a hospital for treatment provide their insurance policy details or a card issued by the Third-Party Administrator (TPA) or insurance company. The hospital then accesses the claim processing portals of respective payers and uploads the required documents for preauthorisation or claim approval process. On receipt of the pre-authorisation/claim form, the insurance company/Third Party Administrator (TPA) authenticates and digitises the form using their internal claims processing portal. The claims are then adjudicated by the relevant team.
“Often, patients keep waiting throughout the day for this process to be completed leading to delay in discharge from hospital and additional room rent charges. With NHCX, they can monitor the progress of claim settlement. It is a major relief,” said a senior doctor.