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    NHCX Presentation

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    NHCX Presentation

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    NHCX PRESENTATION

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    10 views7 pages

    NHCX Presentation

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    foxan67683

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 7

    GENERAL INSURANCE COUNCIL

    National Health Claims Exchange


    An Initiative by
    National Health Authority ( NHA ) –
    Govt. Of India

    1
    Promoting General Insurance in India
    National Health Claims Exchange –
    Key Objectives

     Interoperable Health Claims Via National


    Health Claims Exchange
     To standardize the Interchange of Information
    Between Payers and Providers and Other
    Stakeholders

    Promoting General Insurance in India 2


    Overview of National Health Claims Exchange
     NHCX is a standardized health claim platform to enable automation of the health claim-
    related information exchange between payers, providers, beneficiaries, and other relevant
    entities.
     Providers are Hospitals, Clinics Diagnostic Centers, Labs, Pharmacies whoever are Care Providers
     Beneficiaries are those covered under PMJAY Scheme, Insurance Policies
     Payers- SHA, Insurers , TPA as applicable

    3
    Promoting General Insurance in India
    Capabilities of NHCX
    NHCX aims to provide a set of digital services to the various stakeholders in the ecosystem

    Digital Contract
    Policy details Management
    Provider Facility Creation of Digital MoU moving
    Smart Contracts Info standard Policy towards paperless
    Claim Status Automatic transfer Machine readable markup language contracts
    Track status of any of payments on information on to describe key
    Coverage Eligibility claim across payers claims approval providers that can elements of their
    Check policy validity by from pre-auth to through HCX be used by payers policy
    provider including payment platform (enabled for empanelment or
    exclusions by payer) fraud check during
    claim processing

    4
    Key use cases that will happen through NHCX on
    getting Onboarded

    1. Check Coverage eligibility- Providers can check the eligibility of a beneficiary with the payors
    2. Preauthorization Request Submission: Providers can submit the Preauth request of a beneficiary with the
    payors

    3. Predetermination Request Submission- Providers can submit the Predetermination Request of a claim with
    the payers

    4. Claim Request Submission - Providers can submit the Claim Request of a beneficiary with the payors

    5. Payment Notice- Payers to submit the Payment status of a claim with the providers

    6. Communication Request Submission - Payers can communicate the remarks of a claim/preauth with
    providers

    7. Reprocess Request- Providers to request payers to reprocess the claim when it is partially paid or rejected
    by the claim processing officer

    5
    NHCX – Progress So Far
    National Health Claims Exchange (NHCX) developed by NHA in consultation with IRDAI for improving health insurance claims
    processing in India.

    Major Health Insurance players integrating


    with NHCX

    51 28
    Insurance companies, TPAs & DSCs Insurance companies, TPAs and DSC are
    onboarded now live

    NHCX already live in PMJAY IT system in 18 States/UTs, roll out in more


    states and UTs expected soon

    6
    THANK YOU

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