National Health Authority (NHA) and IRDAI Partner to Accelerate ABDM Integration and NHCX Adoption

National Health Authority (NHA) and IRDAI Partner to Accelerate ABDM Integration and NHCX Adoption

The National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) have collaborated to activate the National Health Claim Exchange (NHCX), a digital health claims platform developed by the National Health Authority. This collaboration is in response to a circular issued by IRDAI in June 2023, directing all insurers and providers to integrate with the NHCX.

NHCX is designed to facilitate the exchange of claims-related information among various stakeholders in the healthcare and health insurance ecosystem. Integration with NHCX is expected to streamline health claims processing, promoting efficiency and transparency in the insurance industry to the benefit of policyholders and patients.

A three-day workshop held from November 7th to 9th in New Delhi focused on onboarding hospital providers onto NHCX and enabling insurance companies to fully integrate with the platform. This workshop, the third in a series organized by NHA and IRDAI, followed previous sessions in August and October of the same year, which saw participation from insurance companies and Third Party Administrators (TPAs).

With over 150 professionals representing 45 organizations, including insurance companies, TPAs, and hospitals, these workshops demonstrated significant progress. Organizations were encouraged to choose their most popular retail product and one network hospital to pilot the operationalization of NHCX.

Ten hospitals, including Jupiter Hospital, Thane; Kauvery Hospitals, Chennai; A J Hospital Research and Research Centre, Bengaluru; Sarvodaya Hospital, Faridabad; Fortis Hospital, Gurugram; Fortis Hospital, Noida; Shri Balaji Action Hospital, Delhi; Sanar International Hospital, Gurugram; Centre for Sight, Dwarka, Delhi; and Narayana Hrudayalaya, Delhi, were successfully onboarded onto the NHCX provider Registry during this workshop.

Furthermore, the hospital/claim management systems (HMIS) of these hospitals achieved the required M1 integration of the Ayushman Bharat Digital Mission (ABDM), a crucial step for NHCX integration. M1 integration allows software to create and verify the Ayushman Bharat Health Account (ABHA).

The workshop also witnessed eight insurance companies/TPAs completing full integration with NHCX, bringing the total count to 12. Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance Company, and HDFC Ergo Insurance had previously completed full integration in the October workshop. In this workshop, seven insurance companies and one TPA, including ICICI Lombard General Insurance, The New India Assurance Company, Care Health Insurance, Go Digit General Insurance, Acko General Insurance, Tata AIG General Insurance company, Paramount TPA, and United India Insurance Company, successfully completed NHCX integration.

To encourage the adoption of digital health transactions and the digitization of patient health records, NHA announced financial incentives under the Digital Health Incentive Scheme (DHIS) from January 2023. Under DHIS, hospitals will receive financial incentives of Rs 500 per claim or 10% of the claim amount, whichever is lower, for every insurance claim transaction through NHCX, promoting efficiency in insurance claim processing.

With the enthusiastic participation of insurance companies and providers, a full-scale launch of this transformative initiative is expected in the near future.