Close-up of a medical insurance form with stethoscope
| Photo Credit: GETTY IMAGES
Thirty-four insurers and Third-Party Administrator (TPAs) are currently living on National Health Claims Exchange (NHCX) and approximately 300 hospitals are ramping up to start sending their claims on NHCX, as on July 21, the Health Ministry noted according to the information submitted in Lok Sabha on Friday.
Supported by the Insurance Regulatory and Development Authority of India (IRDAI) and General Insurance Council (GIC), the NHCX was brought in by the Union government to enable standardised and faster health insurance claim processing.
Responding to a question on the issue by MPs Dhairyasheel Sambhaji Rao Mane and Sudheer Gupta, Minister of State for Health and Family Welfare Prataprao Jadhav said the NHCX is a gateway under the Ayushman Bharat Digital Mission (ABDM).
The NHCX aims to streamline and standardise health insurance claim processing, enhancing efficiency in the insurance industry and improving the patient experience. It serves as a gateway for exchanging health claim information among insurers, third-party audit, healthcare providers, beneficiaries, and other relevant entities and ensures interoperability, machine readability, auditability and verifiability, making the information exchange accurate and trustworthy. This system will enhance efficiency and transparency in the insurance industry, benefiting policyholders and patients.
He added that at present, all members of the eligible families irrespective of age are covered under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY).
The scheme provides health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation to 55 crore individuals corresponding to 12.34 crore families. Additionally, no expert committee has been set up for extending the health benefits to cover senior citizens aged 70 and above, the Minister informed the Lower House.
