There is going to be a revolutionary change in the field of health insurance, which will benefit the insured. Very soon all health insurance claims will be settled by hospitals and insurance companies through a single window National Health Claims Exchange (NHCX). Health Ministry sources said that NHCX, developed by the National Health Authority (NHA), is ready and is undergoing testing. Currently, most of the insurance companies selling health insurance have their own platforms to approve claims.
what is the system now
“NHCX will have a standard format for processing claims by insurance companies,” a source told TOI. Currently, patients who go to the hospital for treatment give their insurance policy details to the Third Party Administrator (TPA) or the card issued by the insurance company. The hospital then accesses the company’s claim processing portal and uploads the required documents for pre-authentication or claim processing.
The insurance company or TPA then authenticates and digitizes the form through its internal claim processing portal. After this the decision on the claim is taken by the concerned team. These data exchanges often involve PDFs or manual paperwork, which increases processing time and increases the risk of errors.
What is the purpose of NHCX?
Health ministry officials said the NHCX is the result of a collaborative effort between the NHA and IRDAI, responsible for implementing the Ayushman Bharat PM Jan Arogya Yojana. A senior official said, “IRDA will continue to regulate the insurance industry. We are not going to get involved in it. The health ministry’s objective behind developing NHCX is only to act as a facilitator for faster and more transparent processing of health insurance claims. To act as.”
Complaints about rejection of claim also
He said the process right now is so complex that patients are often forced to wait for long periods of time to get approval. An official said there have also been complaints of claims being rejected on alleged unfair grounds. The records on NHCX can be used to design systems to be added to the platform to reduce such cases in the future.
