About National Health Claims Exchange:
- It is developed under the Ayushman Bharat Digital Mission (ABDM).
- It is developed by the National Health Authority (NHA) in consultation with Insurance Regulatory and Development Authority of India (IRDAI).
- It aims to streamline and standardize health insurance claim processing, enhancing efficiency in the insurance industry and improving the patient experience.
- Purpose: To streamline and standardize the processing of health insurance claims across the country, leveraging the Fast Healthcare Interoperability Resources (FHIR) standards to ensure interoperability across diverse systems.
- Features of NHCX:
- Checking Coverage Eligibility: Providers can verify if a treatment is covered by insurance to avoid unexpected costs.
- Pre-Auth Request Submission: Hospitals can request approval from insurers before starting treatment.
- Predetermination Request Submission: Providers can ask for an estimate of benefits for a treatment before it begins.
- Claim Submission: Hospitals submit claims in a standard format for easier processing by insurers.
- Payment Status: Hospitals can check the payment status of submitted claims, ensuring everyone stays informed.
- Communication Request: Providers can send questions or requests for more information through NHCX.
- Reprocess Request: If a claim has issues, providers can request a review for a solution.
