Mrs Anuradha, aged 30, married with two kids, working at an MNC, was admitted to a hospital for nerve-related issues. Upon diagnosis, it was found that she had brain tumours that had to be operated on immediately. Anuradha has a personal health insurance plan for Rs.5 Lakhs from XYZ company and a group health insurance policy provided by her MNC for Rs.5 Lakhs from ABC company. When she was admitted to the hospital, the surgery cost was approximated to be Rs.8 lakhs, which meant that she had to use both health insurance plans.
Following this, Anuradha submitted her insurance details to the hospital’s insurance desk. Now, the hospital staff had to upload the claim details in two different portals, and various factors are different for both portals, such as cashless claim approval time, documents required for claim processing, etc. This led to a delay in the cashless approval, and in the meantime, it created unnecessary pressure on the family members of Anuradha, as they had to decide whether they should arrange the remaining funds or the approval would come. This is the problem faced by many customers and hospital staff when dealing with multiple insurance companies. This is because each insurance company has its own portal, which has different conditions and requirements for claim processing, ultimately leading to unnecessary delays in claim settlement.
To overcome this issue, the National Health Authority (NHA)—the apex body that manages the Ayushman Bharat Scheme—along with the Insurance Regulatory and Development Authority of India (IRDAI), has developed a one-stop portal that could be utilized by all insurance companies and hospitals across the country to process their health claims.
What’s on this page?
Common Questions About the National Health Claim Exchange Portal (NHCX)
1. What is this portal called?
The portal is called the National Health Claim Exchange portal (NHCX). It was developed by the Health Ministry of the Government of India to simplify the claim filing process in India. This is part of a 100-day100-day plan developed by the Union Health Ministry for the event the BJP government returns to power in the country.
2. Why is NHCX developed, and what is the need for it?
Almost every hospital in India that has partnered with multiple insurance companies must use its portal to file health insurance claims, which is time-consuming. A national health claim exchange portal would reduce the time taken to file a claim by streamlining the process and creating a common portal for everyone.
3. Is it mandatory for hospitals to join this portal?
No, hospitals or insurers don’t need to join this portal. According to the ministry, the insurance industry demanded that a common portal for raising health insurance claims be developed so that the processing time would be reduced.
4. What are the advantages of this portal?
The advantages of the National Health Claim Exchange (NHCX) are multifold:
- A single portal would reduce the hospitals’ clerical costs, as the new portal could reduce manpower.
- One portal can be used to raise claims and upload documents from multiple insurance companies.
- The claims processing time and cashless approval time would decrease, benefiting the policyholders.
- Policyholders can access data on the number of claims processed by insurance companies and the turnaround time for processing these claims.
- It would also help create portable digital health records that insurance companies could utilize for portability and in many other ways.
- It provides standardization and interoperability between the provider (hospital/ lag/ diagnostic center) and the payer (insurance company/ TPA/ Government scheme)
- It serves as a single platform and gateway for exchanging claims-related information between the payer and the service provider.
5. What else is being developed in addition to the NHCX portal?
The second goal of the government of India is to develop an e-Vin portal for vaccine management. This portal would be similar to the Co-WIN portal developed by the Government of India to handle COVID-19 vaccines.
6. How will the e-Vin portal work?
The e-Vin portal will be used to enrol children at birth and record all their vaccinations so that a digital certificate can be given mentioning all the vaccines administered. The government of India plans to extend this portal to all anganwadis and schools so that children’s vaccine details will be recorded on a digital platform.
7. What are BHISHM cubes that the GOI develops?
The other important development that the Ministry of Health takes up under the Government of India is the development of BHISHM cubes- the Bharat Health Initiative for Sahyog, Hita, and Maitri. BHISHM cubes are portable medical centres and operation theatres that can be dispatched immediately in case of disasters and health emergencies. These cubes could be life-saving machines as it would not be possible, or there would be a delay in shifting the injured patients from the place to the hospital.
8. Who is developing the BHISHM cube?
The BHISHM cubes were developed by the Ministry of Health and are proposed to be stationed at all the All India Institutes of Medical Sciences and other major central government hospitals, such as PGI—Chandigarh and JIPMER—Puducherry. These cubes would be handled by trained manpower and deployed in case of emergencies, such as disasters.
Finally, the National Health Claims Exchange (NHCX) aims to provide standardization and interoperability of health claims and also benefit the insurers and hospitals through seamless data exchange between a provider (hospital/lab/ diagnostic centre) and the payer (insurance company/ TPA/ Government scheme). We advise you and your family on health insurance coverage based on your risk profile. To assess your risk and know how much health insurance is required, please book a call with Ethika Insurance today.
