What is the National Health Claim Exchange?

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CategoryHealth

Last Updated11/06/2024

The Health Ministry along with the Insurance Regulatory and Development Authority of India (IRDAI) are working on measures aimed at allowing patients to access quality healthcare swiftly and with reduced out-of-pocket expenditure.

The Ministry and IRDAI are launching the National Health Claim Exchange (NHCX), a digital platform which will bring together insurance companies, healthcare sector service providers and government insurance scheme administrators.
The NHCX will serve as a gateway for exchanging claims-related information among various stakeholders in the healthcare and health insurance ecosystem.
Twelve insurance companies and one TPA (Third Party Administrator) have completed the NHCX integration.
A timeline has been fixed for insurance claims of cashless claims. The insurance authority has said that all cashless claims have to be processed within three hours of the receipt of discharge authorisation from the hospital.
To encourage adoption of digital health transactions and digitisation of patient health records in the country, the National Health Authority had announced financial incentives under the Digital Health Incentive Scheme (DHIS) from January 2023.
Under the DHIS, there is a provision that for every insurance claim transaction through NHCX, financial incentives of ₹500 per claim or 10% of the claim amount, whichever is lower, would be given to hospitals.

Health insurance is an important policy strategy to provide health care services as well as reduce high out-of-pocket expenditure which burden individuals.
Health insurance contributes to approximately 29% of the total general insurance premium income in India.
The primary hurdle in health insurance today lies in improving the relationship between hospitals and insurance companies.
Building trust among policyholders hinges on delivering efficient services.
While challenges like data breaches are being effectively tackled, the NHCX stands as an ongoing benefit for all involved, facilitating smoother operations within the healthcare space.