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Mahesh

16/06/24 20:27 PM IST

National Health Claim Exchange

In News
  • 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. 
About NHCX
  • The NHCX will serve as a gateway for exchanging claims-related information among various stakeholders in the healthcare and health insurance ecosystem.
  • The integration with NHCX is expected to enable seamless interoperability of health claims processing, enhancing efficiency and transparency in the insurance industry, benefiting policyholders and patients.
  • The insurance industry is poised to support the implementation of this system by facilitating streamlined interactions between hospitals and insurers, establishing a seamless, paperless, and secure contractual framework.
  • Acting as a centralised hub for all health claims, the NHCX will significantly alleviate the administrative burden on hospitals, which currently contend with multiple portals for various insurers.
Cashless Claims
  • 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.
  • The insurance regulator has set the insurance provider a deadline of July 31 to put systems and processes in place to ensure the smooth facilitation of this latest directive. 
Other Incentives
  • 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.
Challenges
  • 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, adding that the push towards digitisation requires active involvement from both parties, necessitating upgrades to current IT systems and enhanced workforce training.
  • “Issues such as discharge delays and miscommunication between hospitals and insurers further complicate matters.
  • Building trust among policyholders hinges on delivering efficient services.
  • The NHCX portal aims to streamline the claims process by bringing all stakeholders onto one platform, reducing claim times and standardising procedures.
  • 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.
  • The NHCX will reduce manual workload and accelerate the entire process, enabling easy tracking leading to better customer satisfaction and also help in fraud detection.
Source- The Hindu

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