The IRDAI And NHA to Develop the National Health Claim Exchange to Speed Up the Cashless Claims
Ketki Jadhav
Jul 08, 2022
Listen to The IRDAI And NHA to Develop the National Health Claim Exchange to Speed Up the Cashless Claims
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Insurance Regulatory and Development Authority of India (IRDAI) and the National Health Authority (NHA) will develop a National Health Claims Exchange, which will be a digital platform to settle cashless health insurance claims faster.
Here are the key facts:
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The National Health Claims Exchange will be developed, which will serve as a digital platform for settling cashless health insurance claims.
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In light of a presentation by the CEO of NHA, Mr R S Sharma, Chairman of IRDAI, Debashish Panda has proposed the creation of a working group with representation from the industry. The group will decide how to make the largest segment of general insurance in India attract more people to buy Health Insurance.
Before moving to how the National Health Claim Exchange will help speed up cashless claims, let's know the basics:
The IRDAI is a regulatory body set up under the jurisdiction of the Ministry of Finance, Government of India and constituted in accordance with the Insurance Regulatory and Development Authority Act, 1991. It is tasked with regulating and licensing the insurance and re-insurance industries in India.
The NHA is an apex body responsible for implementing India's flagship public health insurance/assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
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Currently, the Health Insurance cashless claim settlement is as below:
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The patient has to submit a Cashless Claim Form to the insurer through a letter or email. The insurer needs to be notified at least 5 days before the treatment date and within 24 hours of hospitalisation in case of emergency treatment.
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After receiving the Claim Form, the insurance company will intimate the hospital. Whereas in case of an emergency, the hospital has to fill up and submit your Cashless Claim Form to the insurance company.
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The insurance company will issue a confirmation letter, which you need to provide to the hospital, and the insurance company will cover your medical expenses. In case of an emergency medical treatment, the insurance company will directly send an authorisation letter to the hospital and cover your medical expenses.
The current process needs a lot of paperwork that has to be done manually, along with the submission of the required documents either physically or online (scanned copies). Furthermore, hospitals are required to coordinate with several insurers and aggregators and keep track of the insurance claims. The entire process can take about 5 to 7 hours, which delays discharging the patients and the new patients in need have to keep waiting.
In April 2021, the Delhi High Court had asked the health insurance companies not to take 6 to 7 hours for approving the bills and to approve the cashless treatment within 30 to 60 minutes, as delay in discharging patients leads to delay in admitting the needy patients. This judgement is finally coming to practice with the proposal of a Health Claims Exchange.
The proposed Health Insurance cashless claim settlement is as below:
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The hospital will receive the digital KYC through the Health Management Information System from the Ayushman Bharat Health Account (ABHA), which consists of a 14-digit unique number. The ABHA consists of your entire health record, such as your medical history, the diseases you had/have, the hospitals you visited, doctors under whom you were treated, the medical tests you had, medicines you used or still using, diagnosis of your reports, your existing test reports and x-rays, discharge summary, etc. The health records are updated after your consent and will be digitally secured.
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The patient needs to file an e-claim to avail of a health insurance benefit. The insurer and hospital can obtain the digital health records only upon providing them with the Ayushman Bharat Health Account number.
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The data will be uploaded to the National Health Claims Exchange and routed to the insurance company or aggregator.
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The insurance company will be then able to verify the e-claim digitally.
The proposed process is not only quick and hassle-free but also reduces the cost per claim to the insurer. The policyholders and hospitals can track the claim status online. Moreover, it also enables automatic fund transfer of the claim amount. It will help insurers have a unified platform for claims and policyholders' medical history, which will help in reducing the number of insurance frauds. The proposed process will save a considerable amount of time the hospitals have to spend on claims and provide them with easy access to the patient's medical history. Furthermore, the policyholder will be able to provide complete medical data to the hospital, track the claim status anytime and experience a faster and hassle-free claim process. The move proves to be beneficial for all the parties; insurers, hospitals, and policyholders.
Warm Regards,
Ketki Jadhav
Content Writer