National Health Claim Exchange to Roll Out Soon: NHA Chief

The platform, developed as part of the Ayushman Bharat Digital Mission (ABDM), aims to streamline health insurance claims processing.

The National Health Claim Exchange (NHCX), a digital health claims platform, is set to become operational within the next 15-20 days, said Deepti Gaur Mukherjee, CEO, National Health Authority (NHA).

NHCX, developed as part of the Ayushman Bharat Digital Mission (ABDM), aims to streamline health insurance claims processing, offering efficiencies and economies of scale to stakeholders.

Mukherjee, noted the transformative impact of the NHCX during her address at the Global Conference of Actuaries in Mumbai on February 14.

She said, "The National Health Claim Exchange is going to be a game-changer. The IRDAI (Insurance Regulatory and Development Authority of India) has been collaborating with us. This product is completely ready, and we should be able to launch it in 15-20 days."

The IRDAI has been collaborating closely with the NHA on this initiative. The NHCX is positioned as a tech-enabled platform designed to facilitate faster claim processing for policyholders and reduce costs for insurance companies. It serves as a digital exchange for claims-related information among insurance companies, claimants or beneficiaries, and regulators.

Encouraging Insurers to Join the NHCX Platform

Mukherjee urged insurance companies to come on board and leverage the benefits of the NHCX. The platform's digital capabilities claim to streamline and enhance the overall health insurance ecosystem, providing a standardized and efficient mechanism for claims processing.

In June 2023, the IRDAI issued a directive for insurance companies to integrate with the NHCX. The platform is expected to enhance the efficiency of health insurance claim settlement processes, ensuring quicker and more accurate procedures.

Previously, Debasish Panda, chairman, IRDAI, highlighted the platform's role in promoting prudent underwriting processes, emphasizing its potential positive impact on the health insurance sector.

The collaboration between insurers and the NHCX is anticipated to result in improved services and experiences for policyholders.

Addressing the 'Missing Middle'

Talking about the general and health insurance companies, NHA chief Mukherjee encouraged them to utilize the data and good practices developed under the Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (PMJAY) to create innovative products for the 'missing middle'—the population not covered by the scheme.

"There is a huge missing middle that all of us are aware of. Good practices that we are generating can be leveraged by the healthcare providers. And then you all come up with innovative schemes for those not covered by us," she added.

Leveraging the standardized treatment packages and costs introduced by the government, insurers can design schemes tailored to the specific needs of the uncovered population.

Fraud Control Measures & Digitization

Addressing concerns about potential fraud, Mukherjee assured that the NHA has implemented robust fraud control measures, including AI and audit systems.

She stated, "In any system, big or small, frauds happen. But we are prepared. (In the case of Ayushman Bharat) frauds are extremely low at 0.3-0.4 percent. The more we digitize, the more we sanitize…and the chances of fraud are going to be reduced. Simultaneously, there is the deterrence part of it - (perpetrators) can face criminal action and financial penalties."

The NHCX platform's integration with insurance processes is expected to bring about increased efficiency, reduced costs, and improved services for both insurers and policyholders.

In another development, in November, to achieve "Insurance for All," the central government considered establishing a health sector regulator that would also facilitate affordable health insurance coverage for all citizens.

Reportedly, preliminary discussions have been held between the finance and health ministries over the need for a sector watchdog. This strategic move aligns with the government's mission to achieve "Insurance for All" while expanding health insurance and making it affordable for the citizens.