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- National Health Authority (NHA) invites participation on the ‘National Health Claims Exchange (HCX)-Sandbox’ under Ayushman Bharat Digital Mission (ABDM)
- National Health Authority has been collaborating with insurance regulator Insurance Regulatory and Development Authority of India (Irdai) for developing the Health Claims Exchange.
- NHA announced HCX as a new initiative under the Ayushman Bharat Digital Mission (ABDM)
- National Health Authority will start using the exchange for processing claims under Pradhan Mantri Jan Arogya Yojana.
- Thereafter the exchange will be open for insurance players, hospitals and software vendors, among others.
Need for HCX:
- The current health insurance claims settlement process in the country is mostly manual, non-digital and laborious in nature posing challenges at every stage.
- The current process of exchanging claims lacks standardization leading to high cost of processing each claim.
- To tackle these key challenges and streamline the process of claim settlement, NHA has developed HCX to enable interoperability of health claims.
What is it and how it will operate?
- The HCX serves as a protocol for exchanging claims-related information among various actors, including payers, providers, beneficiaries, regulators, and observers.
- It is designed to be interoperable, machine-readable, auditable, and verifiable which helps ensure that the information being exchanged is accurate and trustworthy.
- HCX will act as a gateway (with validation and routing capabilities) for the ecosystem.
There are two sides to Health Claims Exchange:
- One is the provider side, which are basically hospitals who provide services.
- Another is the payer side, which are insurance companies and state government, who do the payments
Benefits:
- Health Claims Exchange will transform the way health insurance claims are processed as the digital platform will reduce cost and waiting time for processing a claim
- The HCX envisions to standardize the claims process by creating a transparent and rule-based platform that will enable faster claim processing and better patient experience.
The National Health Authority
The National Health Authority (NHA) has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY in alliance with state governments.
The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State.
| The National Health Authority
· The National Health Authority (NHA) has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY in alliance with state governments. · The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State. Pradhan Mantri Jan Arogya Yojana · The Pradhan Mantri Jan Arogya Yojana (PM-JAY) popularly known as Ayushman Bharat was launched in 2018. · It aims to secure the lives of 50 crore individuals that comprises of 10.74 cr poor families including both rural and urban areas with a defined benefit cover of Rs 5 lakh per family. · The scheme covers over nearly 40% of the population targeted towards poorest and the vulnerable. Ayushman Bharat Digital Mission · The mission will create a seamless online platform through the provision of a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems. · It will enable access and exchange of longitudinal health records of citizens with their consent. Key components of Ayushman Bharat Digital Mission · Health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application. · Healthcare Professionals Registry (HPR) and Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine. |
SOURCE: THE HINDU, THE ECONOMIC TIMES, PIB
