India To Get A Health Claims Exchange By August — BQ Exclusive
The IRDAI has asked all insurers to integrate with the 'Health Claims Exchange' portal developed by the NHA.
The dream of quicker resolution of cashless claims at hospitals and swifter discharge of patients is all set to become a reality by Aug. 1.
BQ Prime had reported in July 2022 that the National Health Authority, together with the Insurance Regulatory Development Authority of India, was exploring possibilities of setting up a health claims exchange that would help digitise and standardise claims forms, according to an internal document reviewed then.
The IRDAI asked all insurers to integrate with the 'Health Claims Exchange' portal developed by the NHA, in a meeting held on Thursday, according to four people with knowledge of the matter, who spoke on condition of anonymity as the information is not public yet.
The expected timeline for the launch of the portal is Aug. 1.
However, this is an evolving process and changes will keep coming even after launch, the second of the four people quoted above said. There is definitely a mandate to integrate as soon as possible, the person said.
The discussions in the meeting held with the NHA revolved around training business claims teams of health insurers to operate the portal seamlessly pre- and post-integration, for which workshops are being planned and a roadmap has been charted out, an industry official told BQ Prime on the condition of anonymity.
The move is a win-win for all stakeholders involved, Shanai Ghosh, managing director and chief executive officer at Zuno General Insurance Ltd. (earlier Edelweiss General Insurance), told BQ Prime. "It will help customers, healthcare service providers and insurers. There will be a faster, paperless resolution of claims. Hospitals and healthcare service providers will have to operate just one portal instead of the current multiple portals for different insurers."
The portal is a very good initiative, according to Ghosh. "It will help reduce turnaround time for claim processing, reduce the cost of transactions, eliminate fraud, and ensure uniformity."
Health Claims Exchange
The exchange is expected to integrate hospitals, healthcare service providers, third-party aggregators and insurers onto a single platform to ensure seamless exchange of data and information.
The new process is expected to help policyholders and hospitals track claim status and enable automatic transfer of payments. It will also help in checking for fraud.
Apart from these, it is expected to resolve the following issues:
For Insurers and TPAs: Lack of a unified platform for claim submission; limited or no access to patients' medical histories; and limited fraud analytics.
Hospitals: Limited access to the medical history of patients; large volumes of medical records; different software for multiple insurers or aggregators; and poor efficiency in claim management.
Policymakers: Insufficient information about diseases that can be prevented and limited monitoring and analytics.