Under the Digital Health Incentive Scheme, to encourage efficiency in insurance claim processing, there is a provision that for every insurance claim transaction through NHCX, financial incentives of Rs 500 per claim or 10% of the claim amount, whichever is lower would be provided for the hospitals
The National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) have joined hands to operationalize the National Health Claim Exchange (NHCX), a digital health claims platform developed by National Health Authority.
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 would enable seamless interoperability of health claims processing, enhancing efficiency and transparency in the insurance industry and benefiting the policyholders and patients.
To encourage adoption of digital health transactions and digitization of patient health records in the country, NHA has also announced financial incentives under the Digital Health Incentive Scheme (DHIS) from Jan 2023.
Under the DHIS, to encourage efficiency in insurance claim processing, there is a provision that for every insurance claim transaction through NHCX, financial incentives of Rs 500 per claim or 10% of the claim amount, whichever is lower would be provided for the hospitals. More information on the DHIS is available at: https://abdm.gov.in/DHIS
In this regard, a three-day workshop was organized from 7th to 9th November in New Delhi, aimed mainly at hospital providers to onboard on the NHCX and insurance companies to fully integrate with the NHCX.
This workshop was the third in a series of workshops that have been organized by NHA and IRDAI. The first two workshops were organized in August and October of this year and had participation from insurance companies and TPAs.
Over 150 professionals representing 45 organisations – insurance companies, TPAs, and hospitals have participated in these workshops. Considering the encouraging progress made by the insurance companies in these workshops, the organisations were advised to select their most popular retail product along with one network hospital to pilot the operationalization of NHCX.
This workshop saw participation from 10 hospitals, each assigned to an insurance company.
The technical and business teams of these hospitals were guided by teams from NHA, IRDAI and NRCeS (National Resource Centre for EHR Standards) to onboard on the NHCX.
The workshop also saw completion of full integration with NHCX by eight insurance companies/TPAs, taking the total count to 12 insurance companies having successfully completed the NHCX integration.
Four insurance companies, namely Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance Company and HDFC Ergo Insurance had already completed the full integration in the second workshop in October. During this workshop, seven insurance companies and one TPA, namely ICICI Lombard General Insurance, The New India Assurance Company, Care Health Insurance, Go Digit General Insurance, Acko General Insurance, Tata AIG General Insurance company,United India Insurance Company, Paramount TPA, successfully completed NHCX integration.
At the end of the workshop, 10 hospitals namely Jupiter Hospital,Thane ; Kauvery Hospitals, Chennai; A J Hospital Research and Research Centre, Bengaluru ; Sarvodaya Hospital, Faridabad; Fortis Hospital, Gurugram; Fortis Hospital, Noida; Shri Balaji Action Hospital, Delhi; Sanar International Hospital, Gurugram; Centre for Sight, Dwarka, Delhi; and Narayana Hrudayalaya, Delhi were onboarded on the NHCX provider Registry.
In addition, the hospital/claim management systems (HMIS) of these hospitals, namely M/s Jupiter Hospitals, Kauvery Hospitals, Akhil systems, Kare Expert, Fortis Hospitals, Narayana Hrudayalya and Vitraya Technologies Private Limited were able to complete the requisite M1 integration of Ayushman Bharat Digital Mission (ABDM), which is an essential step to complete NHCX integration. The M1 integration enables a software to create and verify Ayushman Bharat Health Account (ABHA).
Considering the enthusiastic participation by the insurance companies and providers, a full scale launch of this transformational initiative is expected soon.
This initiative is being undertaken in the context of a circular issued by IRDAI in June 2023, whereby the insurance regulator had advised all insurers and providers to onboard the NHCX.
For more information on the National Health Claims Exchange (NHCX), see https://sbxhcx.abdm.gov.in/