Hospital patients can look forward to much-needed relief in the processing of their health insurance claims. The new National Health Claims Exchange (NHCX) promises to bring a raft of benefits to patients and health insurance providers alike by streamlining the health claims approval process.
The NHCX improves the health care claims process by centralizing the exchange of insurance-claims-related information. The system is being developed by the National Health Authority (NHA) in conjunction with the Insurance Regulatory Development Authority of India (IRDAI), the top insurance regulatory body in the country.
At least 33 major companies offering health insurance in India have joined the NHCX, giving it the momentum it needs to succeed.
Too Many Steps Cause Delays
The slow and cumbersome method of health care claims processing has caused patients to suffer long delays and extra costs as they wait to be discharged.
Currently, patients who enter a hospital must first provide their insurance policy information or present a card issued by a Third-Party Administrator (TPA) or insurance company. The hospital then uploads the documents to the claim processing portals of the health insurance provider for pre-authorization or claim approval. The insurance company or TPA then authenticates and digitizes the form within their internal claims processing portal. Finally, the claims are approved or rejected by the adjudicating teams.
The slowness of this multistep system incurs penalties for patients. “Often, patients keep waiting throughout the day for this process to be completed, leading to delays in being discharged from the hospital and additional room rent charges,” said a senior doctor.
Centralization Is Key
The bottlenecks in the current health claim approval process are caused by the exchange of information taking place across multiple platforms. Centralizing the exchange of information in the NHCX will speed up the processing time, said government sources.
With the new system, patients no longer will be kept waiting in the dark for long periods of time. Rather, they will be able to monitor the status of their claims through their mobile devices, said a top official of the NHA.
The senior doctor concurred, citing the ability of patients to monitor the progress of their claim settlement as “a major relief.”
Added Benefits
Not only will the NHCX expedite the insurance claims process, it will also make the entire process transparent by giving the Insurance Regulatory Development Authority of India (IRDAI) access to the claims settlement status in real-time.
Although the NHCX does not intend to regulate the business, sources say that records generated from the digital platform could become the basis for additional processes that would add value. For example, systems could be developed to detect and deter instances of malpractice, such as the refusal to accept a claim on unjust grounds.
According to the NHA official, some companies have already started processing claims through the NHCX on a trial basis. Among them is HDFC Ergo, a major player in the health insurance industry that reportedly processed its first claim through NHCX.
The official launch of the NHCX platform is expected soon and will include all major features, said the NHA official.
