‘National Health Claims Exchange (HCX)-Sandbox’ under Ayushman Bharat Digital Mission (ABDM)

Last Updated20/04/2023

National Health Authority (NHA) invites participation on the ‘National Health Claims Exchange (HCX)-Sandbox’ under Ayushman Bharat Digital Mission (ABDM)

National Health Authority has been collaborating with insurance regulator Insurance Regulatory and Development Authority of India (Irdai) for developing the Health Claims Exchange.
NHA announced HCX as a new initiative under the Ayushman Bharat Digital Mission (ABDM)
National Health Authority will start using the exchange for processing claims under Pradhan Mantri Jan Arogya Yojana.
Thereafter the exchange will be open for insurance players, hospitals and software vendors, among others.

The current health insurance claims settlement process in the country is mostly manual, non-digital and laborious in nature posing challenges at every stage.
The current process of exchanging claims lacks standardization leading to high cost of processing each claim.
To tackle these key challenges and streamline the process of claim settlement, NHA has developed HCX to enable interoperability of health claims.

The HCX serves as a protocol for exchanging claims-related information among various actors, including payers, providers, beneficiaries, regulators, and observers.
It is designed to be interoperable, machine-readable, auditable, and verifiable which helps ensure that the information being exchanged is accurate and trustworthy.
HCX will act as a gateway (with validation and routing capabilities) for the ecosystem.
There are two sides to Health Claims Exchange:
One is the provider side, which are basically hospitals who provide services.
Another is the payer side, which are insurance companies and state government, who do the payments

Health Claims Exchange will transform the way health insurance claims are processed as the digital platform will reduce cost and waiting time for processing a claim
The HCX envisions to standardise the claims process by creating a transparent and rule-based platform that will enable faster claim processing and better patient experience.