At least 33 major health insurance companies join govt's centralised claims-related info exchange

New Delhi: Of the major health insurance companies in India, at least 33 have joined the National Health Claims Exchange (NHCX), a centralised platform developed by the government for the exchange of insurance claims-related information, ToI reported on July 15. This new system aims to expedite the insurance claims process and make it more transparent, with real-time access to claims settlement status by the Insurance Regulatory Development Authority of India (IRDAI). Citizens will also be able to monitor their insurance claim status through their mobile devices, the report (by Durgesh Nandan Jha) said.

Currently, insurance claims are processed through multiple platforms, leading to delays. The implementation of NHCX will streamline this process. According to government sources, some companies have already started trialing the NHCX for claims processing, with an official launch expected soon.

A senior official of the National Health Authority (NHA), which developed the centralised platform, elucidated, "Citizens will also be able to see the status of their insurance claim through the mobile."

Recently, HDFC Ergo, a significant player in the health insurance sector, successfully processed its first claim through the NHCX. This platform, developed by the NHA in collaboration with IRDAI, marks a significant step towards improving the insurance claims process.

Sources familiar with the matter stated that, at present, the NHCX does not aim to regulate the business. However, the records generated from this digital platform may be instrumental in devising future systems to prevent malpractices, such as the unjust refusal of claims.

The existing process requires patients to provide their insurance policy details or a card issued by the Third-Party Administrator (TPA) or insurance company when they visit a hospital for treatment. The hospital accesses the claim processing portals of the respective insurers and uploads the necessary documents for pre-authorisation or claim approval. Upon receiving the pre-authorisation or claim form, the insurance company or TPA digitises and authenticates the form using their internal claims processing portal. The claims are then adjudicated by the relevant team.

A senior doctor highlighted the inconvenience of the current system, stating, "Often, patients keep waiting throughout the day for this process to be completed, leading to delay in discharge from hospital and additional room rent charges. With NHCX, they can monitor the progress of claim settlement. It is a major relief."

The NHCX aims to reduce processing time and offer transparency in the claims settlement process, addressing a major pain point for patients and insurers alike. As the platform prepares for its official launch, it promises to bring significant improvements to the health insurance sector in India.