One portal for all health insurance claims: How claim settlement process will change with NHCX

NHCX is a digital platform developed by the National Health Authority and Union Ministry of Health and Family Welfare as part of the Ayushman Bharat Digital Mission. It is being created on the recommendation of the joint working group of the Insurance Regulatory and Development Authority of India (Irdai) and NHA.It brings all the players involved in the claim process, including payers and providers, to one place. Irdai has urged all the players to onboard the platform, and many have already done (Text by Riju Mehta/ET Bureau).

Here is a look at how claim settlement process will change with NHCX.

Policyholder (digital KYC with Ayushman Bharat Health Account) forwards cashless claim to hospital.
No manual feeding; standardised digital claim form.

Hospital uses standard claim format on NHCX.
Single gateway, no separate insurer portal access required.

NHCX validates the claim data and routes to the required insurer/TPA.
Automatic checking of policyholder details.

Insurer/ TPA digitally verifies submitted forms and auto-adjudicates (in some cases manually) the claim.
No digitisation of forms by insurer; automatic adjudication.

Hospital contacts policyholder for balance payment, if any.
Waiting time cut to 1-2 hours, fast approval, cost reduction expected.

Policyholder’s discharge processed.
Higher transparency as policyholder can track approval process.