About National Health Claims Exchange (NHCX):
- NHCX is developed under the Ayushman Bharat Digital Mission (ABDM) by the National Health Authority (NHA) in consultation with the Insurance Regulatory and Development Authority of India (IRDAI).
- NHCX aims to streamline and standardize health insurance claim processing, enhancing efficiency in the insurance industry and improving the patient experience.
- NHCX serves as a gateway for exchanging health claim information among insurers, third-party auditors, healthcare providers, beneficiaries, and other relevant entities and ensures interoperability, machine-readability, auditability, and verifiability, making the information exchange accurate and trustworthy.
- 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.
