The National Health Claim Exchange (NHCX), a digital health claims platform being developed by the National Health Authority (NHA), is ready and could be operational in the next “15-20 days”, NHA's chief executive officer Deepti Gaur Mukherjee has said.
“The National Health Claim Exchange is going to be a game-changer. The IRDAI (Insurance Regulatory and Development Authority of India) has been collaborating with us. This product is completely ready and we should be able to launch it in 15-20 days,” she said while speaking at the Global Conference of Actuaries in Mumbai on February 14.
Reiterating that it will offer efficiencies and economies of scale to all stakeholders, she urged insurers to come onboard.
In June 2023, the IRDAI had asked insurance companies to onboard the NHCX. The claim exchange, being developed as part of Ayushman Bharat Digital Mission (ABDM), is a digital platform that aims to facilitate faster claim processing for policyholders and reduction in costs for insurance companies. It is meant to serve as a tech-enabled platform for exchanging claims-related information among insurance companies, claimants or beneficiaries and regulators.
In an interview to Moneycontrol last year, IRDAI chairman Debasish Panda had said that the platform would facilitate smoother health insurance claim settlement processes as well as prudent underwriting (process to assess the risks and determine the right premium accordingly).
Insurers should cater to the ‘missing middle’
General and health insurance companies should use Ayushman Bharat-PMJAY (Pradhan Mantri Jan Aarogya Yojana) data available as well as good practices it has developed to devise products for the ‘missing middle’ – the section of population not covered by the scheme. “There is a huge missing middle that all of us are aware of. Good practices that we are generating can be leveraged by the healthcare providers. And then you all come up with innovative schemes for those not covered by us,” she told insurers. The government’s initiative to standardise treatment package and costs will have an important effect on the healthcare ecosystem, she added.
Proportion of frauds low in Ayushman Bharat
The NHA has put in place fraud control measures by using artificial intelligence (AI), audit systems and so on in place. “In any system big or small, frauds happen. But we are prepared. (In the case of Ayushman Bharat) frauds are extremely low at 0.3-0.4 percent. The more we digitise, the more we sanitise…and the chances of frauds are going to be reduced. Simultaneously, there is the deterrence part of it - (perpetrators) can face criminal action and financial penalties,” she said.
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