Govt likely to launch portal to unify insurance claim process

The government is likely to launch the National Health Claim Exchange (NHCX) — a single portal to submit and process health insurance claims across hospitals in the country — in the next two-three months, people familiar with the matter said on Wednesday. For consumers, this would mean shorter wait times, faster pre-authorisation and discharge approvals from insurance companies, and reduced cost of premiums.

Currently, insurance companies have separate portals, making it cumbersome and time-consuming for hospitals, patients, and other stakeholders to process health insurance claims.

The platform is developed by the National Health Authority (NHA), in collaboration with the Insurance Regulatory and Development Authority of India (Irdai), to ensure interoperability and faster processing of health insurance claims.

The NHA and Irdai last year joined hands to operationalise the NHCX. The Irdai, through a circular in June 2023, had advised all insurers and providers to onboard the NHCX. Close to 50 insurance companies, nearly 250 major private hospitals, and other stakeholders have been holding meetings and participating in workshops jointly conducted by NHA and Irdai for full integration of the health insurance companies with NHCX.

“The portal is ready and is likely to be launched in the next two-three months. The claim exchange has been developed as part of Ayushman Bharat Digital Mission (ABDM),” said a senior central government official aware of the matter, requesting anonymity.

Through NHCX, all insurance companies will be on a single platform. It will serve as a gateway for exchanging claims-related information among various stakeholders in the health care and health insurance ecosystem. “The integration with NHCX would enable seamless interoperability of health claims processing, enhancing efficiency and transparency in the insurance industry, benefiting policyholders and patients,” added the official cited above.

Several insurance companies such as Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance Company, and HDFC Ergo Insurance, ICICI Lombard General Insurance, The New India Assurance Company, Tata AIG General Insurance company, Paramount TPA, United India Insurance Company have completed NHCX integration on a pilot basis, according to a government statement issued earlier.

The current process of exchanging claims lacks standardisation across the ecosystem with most data exchange occurring through PDF or manual methods and the processes vary significantly among insurers, TPAs, and providers, leading to a high cost of processing each claim, said the official.

For the provider — hospitals — it would mean single payer network, universal claims format, faster payments by payers, improved patient experience, better visibility of claims status, and paperless operations. For payers — insurance companies — the move could mean a reduction in overhead operational costs, enabling new processes or rules for auto adjudication, fraud control and abuse prevention, reduction in claim processing cost per each claim, paperless operations, and better quality of data for industry and regulators. However, it is not a regulatory framework.

“The nature of having this portal is not regulatory rather the government is working as a facilitator to make life of consumers, and other stakeholders easy as everyone knows processing health insurance claims currently can be a time-consuming and cumbersome exercise. Having said that onboarding by hospitals and insurance providers will be a purely voluntary process,” said another senior official, requesting anonymity.