In a recent update to the Lok Sabha Union Minister of State for Health and Family Welfare Prataprao Ganpatrao Jadhav announced the launch of the National Health Claims Exchange (NHCX) gateway under the Ayushman Bharat Digital Mission (ABDM). The NHCX is designed to streamline and standardize the health insurance claim processing system, aiming to enhance efficiency within the insurance industry and improve the overall patient experience.

The NHCX serves as a critical conduit for the exchange of health claim information between various stakeholders, including insurers, third-party auditors, healthcare providers, beneficiaries, and other relevant entities. This system ensures that the information exchanged is interoperable, machine-readable, auditable, and verifiable, thus making the process more accurate and trustworthy. By fostering a more transparent and efficient insurance industry, the NHCX is expected to significantly benefit policyholders and patients alike.

Supported by the Insurance Regulatory and Development Authority of India (IRDAI) and the General Insurance Council (GIC), the NHCX will facilitate standardized and expedited processing of health insurance claims. As of July 21, 2024, 34 insurers and Third Party Administrators (TPAs) are active on the NHCX platform, with approximately 300 hospitals preparing to start submitting their claims through this new system.

Currently, all members of eligible families are covered under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which provides a health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization. This scheme benefits approximately 55 crore individuals, corresponding to 12.34 crore families, ensuring substantial healthcare coverage across the country.