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National Health Claim Exchange

Context: The Health Ministry and IRDAI are collaborating to launch the National Health Claim Exchange (NHCX), aiming to streamline healthcare access and claims processing.

 

What is NHCX?

NHCX is a communication protocol facilitating the exchange of health claim information between payers, providers, and beneficiaries. NHCX will centralize health claims, enabling seamless interoperability, improving efficiency, and reducing administrative burdens on hospitals. Twelve insurance companies and one TPA have integrated with NHCX. Under the Digital Health Incentive Scheme, hospitals receive financial incentives for digital health transactions through NHCX.

National Health Claim Exchange
National Health Claim Exchange

Current Claim Processing: The existing process lacks standardization and is mostly manual, leading to inefficiencies and variations across insurers and providers.

 

About IRDAI: 

The Insurance Regulatory and Development Authority of India (IRDAI) is a statutory body under the Ministry of Finance, Government of India, regulating the insurance industry. Established in 1999, it’s headquartered in Hyderabad, Telangana. Recently, IRDAI directed health insurance providers to create specialized policies for senior citizens and removed the age limit for purchasing health insurance policies, effective April 1, 2024. It operates with a 10-member body appointed by the government, including a chairman and both full-time and part-time members.

 Source: TH