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Picture Courtesy:  TIMESOFINDIA

Context:

The government is preparing to bring the National Health Claims Exchange under the joint supervision of the finance ministry and the Insurance Regulatory and Development Authority of India (IRDAI).

What is the National Health Claims Exchange (NHCX)?

The NHCX is a new digital system designed to simplify how health insurance claims get processed.

The National Health Authority (NHA) developed the NHCX, under the Ayushman Bharat Digital Mission (ABDM), working closely with the IRDAI (Insurance Regulatory and Development Authority of India), which manages insurance companies.

What are the key objectives of the NHCX?  

To streamline and standardize claims => Making sure everyone—hospitals, insurance companies, and patients—follows the same clear steps when processing a claim.  

To enhance efficiency => When everyone uses the same digital system, it cuts down on paperwork, errors, and delays, making the whole process much more efficient.

How does NHCX work?  

NHCX acts as a central digital "gateway" or a communication hub. It allows all the different groups involved in a health claim to securely share information with each other. These groups include:

• Insurers: The companies that provide health insurance.
• Third-party auditors: Companies that check if claims are correct.
• Healthcare providers: Hospitals, clinics, and doctors.
• Beneficiaries: The patients who have the insurance.
• Other relevant entities: Anyone else involved in the claim process.

Checking Coverage Eligibility => Before a hospital starts a patient's treatment, they can use NHCX to quickly check if the patient's insurance plan covers that specific treatment.

Pre-Authorization Request Submission => For bigger treatments or surgeries, hospitals often need approval from the insurance company before they start. NHCX allows hospitals to send these "pre-authorization" requests digitally.

Claim Submission => After treatment, hospitals submit the actual bill, or "claim," to the insurance company. NHCX ensures all claims go through in a standard, easy-to-read format.

Source: 

TIMESOFINDIA