Government to launch a one-stop-portal to process health Insurance claims

The Indian government is planning to launch a Unified portal that will process health insurance claims across hospitals all over the country. The National Health Claim Exchange (NHCX) one-stop-portal is likely to be launched in the next two-three months. It will certainly benefit the consumers as the current process is very time-consuming.

At present, hospitals are using different private portals to process insurance claims making the process inconvenient for the consumers. This new portal will allow faster processing, as it will bring almost 50 insurance providers under the same umbrella.

New One-Stop-Portal to Revolutionize Health Insurance Claim Processing

The National Health Authority (NHA) is developing this unified portal by partnering with the Insurance Regulatory and Development Authority of India (Irdai). It is to be noted that NHA has implemented the flagship Ayushman Bharat scheme.

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

NHCX, being a unified platform will allow various stakeholders to exchange information relating to claim exchange. “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.

The official further mentioned the lagging behaviour of the current process of exchanging claims which lacks standardisation where most of the data is exchanged through PDF or manual method. The entire process varies significantly among insurers, TPAs, and providers, resulting in high costs for processing each claim, the official stated

This move will heavily benefit all the involved parties. Hospitals, as providers, will gain access to a single-payer network, a standardized claims format, faster payments from payers, enhanced patient experience, increased transparency of claims status, and a shift to paperless operations.

Insurance companies will see a decrease in overhead operational costs, allowing for the implementation of new processes or rules for auto adjudication, fraud control, and abuse prevention. They will also benefit from reduced claim processing costs per claim, a move to paperless operations, and improved data quality for industry and regulatory purposes.

“The nature of having this portal is not regulatory rather the government is working as a facilitator to make the 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 officer.

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