Government Poised To Launch Unified Insurance Claim Portal

The government is expected to introduce the National Health Claim Exchange (NHCX) within the next two to three months, according to sources familiar with the matter. This single portal aims to streamline the submission and processing of health insurance claims across hospitals nationwide. Its implementation promises shorter wait times, accelerated pre-authorisation and discharge approvals from insurance firms, and potentially reduced premium costs for consumers.

Presently, insurance companies operate separate portals, causing inefficiencies and delays in processing health insurance claims for hospitals, patients and other stakeholders. Developed by the National Health Authority (NHA) in collaboration with the Insurance Regulatory and Development Authority of India (IRDAI), the NHCX is designed to promote interoperability and expedite claim processing.

Last year, NHA and IRDAI partnered to operationalise the NHCX, with IRDAI urging insurers and providers to integrate with the platform through a circular in June 2023. Nearly 50 insurance companies, around 250 major private hospitals, and other stakeholders have been engaged in meetings and workshops to facilitate full integration with the NHCX.

The forthcoming portal, developed as part of the Ayushman Bharat Digital Mission (ABDM), will consolidate all insurance companies onto a unified platform, facilitating seamless exchange of claims-related information across the healthcare and health insurance ecosystem. Integration with NHCX is expected to enhance efficiency and transparency in the insurance industry, benefiting policyholders and patients alike.

Several insurance companies, including Aditya Birla Health Insurance, Star Health and Allied Insurance and Bajaj Allianz Insurance Company, have already completed NHCX integration on a pilot basis, as per a government statement issued earlier.

The current claims exchange process lacks standardization, often relying on PDFs or manual methods, leading to high processing costs. NHCX aims to address these inefficiencies by providing a single payer network, universal claims format, and faster payments for hospitals, while reducing operational overheads and improving data quality for insurance companies.

While the government acts as a facilitator to enhance stakeholder experiences, onboarding hospitals and insurance providers onto the NHCX remains voluntary.