The National Health Authority (NHA) extends an invitation to developers and contributors from the general public, particularly those involved in the health insurance and healthcare provider industries, to test the Health Claims Exchange Ecosystem and contribute to it by enrolling in the HCX – Sandbox Environment. On September 23, 2022, NHA announced HCX as a new project under the Ayushman Bharat Digital Mission (ABDM) and later collaborated with several organisations to develop Health Insurance Exchange requirements.

The nation’s existing system for settling health insurance claims is largely manual, non-digital, and challenging causing difficulties at every step. The ecosystem’s present system for transferring claims lacks standardisation, with the majority of data exchange taking place via PDF or manual methods, and processes used by insurers, TPAs, and providers differing greatly from one another, which drives up the cost of processing each claim.

The NHA has created a nationwide Health Claims Exchange (HCX) to facilitate interoperability of health claims in order to address these major issues and streamline the claim settlement process. The HCX is a protocol that allows different parties, such as payers, providers, beneficiaries, regulators, and observers, to exchange information about claims. In order to guarantee that the information being transmitted is accurate and reliable, it is designed to be interoperable, machine-readable, auditable, and verifiable. In order for the ecosystem’s Insurers/TPAs to respond to each FHIR-based e-claim submitted by providers via the HCX through standard protocols (APIs), HCX will serve as a gateway (with routing and validation capabilities).

Through a transparent and rule-based mechanism and a vision to standardise the claims process, HCX will lower operational costs and boost trust between payers and providers. It will also lower the cost of processing claims, speed up pre-authorization or patient discharge approvals, improve patient experience, provide better visibility for tracking claims, and produce better quality data for the industry and regulators.

It is essential that we onboard participants in the HCX ecosystem in order to ensure the success and adoption of the claims network. As a result, it is requested that all interested solution providers, payers, and providers actively participate and use the services of the HCX – Sandbox. The sandbox’s main objective is to assist the ecosystem in testing its specific components against the communication standards and obtaining certification to be a part of the system. A participant can utilise the certification to gain access to the HCX production environment once they have successfully completed the sandbox process.

The interested parties can express their interest in accessing the HCX sandbox by submitting an online application at https://sbxhcx.abdm.gov.in/. The accepted participants are added to the HCX sandbox and provided with the required credentials to enter the sandbox environment upon successful verification. The link also includes the HCX specs and FHIR profiles, as well as all other required papers for participation.

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