The Government of India has built the National Health Claims Exchange (NHCX) gateway under the Ayushman Bharat Digital Mission (ABDM). NHCX aims to streamline and standardize health insurance claim processing, enhancing efficiency in the insurance industry and improving the patient experience. NHCX serves as a gateway for exchanging health claim information among insurers, third-party auditors, 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.

Supported by the Insurance Regulatory and Development Authority of India (IRDAI) and General Insurance Council (GIC), NHCX will enable standardized and faster health insurance claim processing. As on 21.07.2024, 34 insurers and Third Party Administrators (TPAs) are currently live on NHCX and approximately 300 hospitals are ramping up to start sending their claims on NHCX.

Presently, all members of the eligible families irrespective of age are covered under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana. The scheme provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 55 crore individuals corresponding to 12.34 crore families.

The Union Minister of State for Health and Family Welfare, Shri Prataprao Ganpatrao Jadhav stated this in a written reply in the Lok Sabha today.

****

MV

HFW/Update on NHCX/26 July 2024/4