At least 33 of the prominent health insurance firms in India have become part of the National Health Claims Exchange (NHCX), a centralized platform established by the government for sharing information related to insurance claims, as per a report by ToI on July 15. The primary goal of this new system is to streamline the insurance claims procedure and enhance transparency, providing the Insurance Regulatory Development Authority of India (IRDAI) with real-time access to the status of claims settlement. Additionally, citizens will have the ability to track the status of their insurance claims using their mobile devices, as mentioned in the report by Durgesh Nandan Jha.
At present, insurance claims undergo processing across various platforms, causing delays. The introduction of NHCX is set to simplify this procedure. As per government reports, a few companies have commenced testing NHCX for claims processing, and an official rollout is anticipated in the near future.
The centralized platform, developed by the National Health Authority (NHA), will allow citizens to check the status of their insurance claim using their mobile devices, as explained by a senior official.
HDFC Ergo, a prominent entity in the health insurance industry, has recently achieved the successful processing of its inaugural claim via the NHCX. This innovative platform, created through a partnership between the NHA and IRDAI, represents a noteworthy advancement in enhancing the efficiency of insurance claims procedures.
Sources who are knowledgeable about the situation have indicated that, currently, the NHCX has no intention of regulating the industry. Nevertheless, the data produced by this online platform could play a crucial role in developing future mechanisms to combat unethical behaviors, like the unfair denial of claims.
Patients must furnish their insurance policy information or a card from the Third-Party Administrator (TPA) or insurance provider during hospital visits. The hospital then logs into the insurers’ claim processing platforms to submit the required documents for pre-approval or claim validation. Once the pre-approval or claim form is received, the insurance company or TPA verifies and digitizes the form through their internal claims processing system. Subsequently, the claims are reviewed by the appropriate team.
The current system’s inconvenience was emphasized by a senior doctor, who pointed out that patients often have to wait all day for the process to be finished, resulting in delays in hospital discharge and extra room rent charges. With NHCX, patients can keep track of the claim settlement progress, providing significant relief.
The NHCX is focused on decreasing processing time and providing clarity in the claims settlement process, which is a significant challenge for both patients and insurers. With its upcoming official launch, the platform is poised to deliver substantial enhancements to the health insurance industry in India.
