Most big private hospitals in Calcutta are willing to join the National Health Claim Exchange (NHCX), a digital platform which will bring together insurance companies, third-party administrators, healthcare providers and government insurance scheme administrators, representative of the hospitals said at a meeting.
The NHCX portal aims to ensure faster processing and settlement of claims for health insurance.
Representatives of private hospitals took part in an awareness meeting about the NHCX portal in the city on Monday. The meeting was organised by National Insurance, in coordination with the Insurance Regulatory and Development Authority of India, National Health Authority and the General Insurance Council.
A major problem patients face with cashless health insurance schemes is the delay in leaving hospital after being discharged. Often patients have to wait for hours after discharge to get clearance for cashless insurance.
The Insurance Regulatory and Development Authority of India (IRDAI) recently issued a circular saying insurers must approve cashless claims within three hours of receiving a discharge request from the hospital.
According to the health ministry, the NHCX will serve as a gateway for exchanging claims-related information among stakeholders in the healthcare and health insurance ecosystem. The integration with NHCX is expected to enable seamless interoperability of health claims processing and enhance efficiency and transparency in the insurance industry.
“Representatives of more than 175 hospitals attended Monday’s session to spread awareness on the NHCX portal. The portal is set to enhance data standardisation and facilitate faster claim
processing and settlement as well as tracking,” said a senior official of an insurance company.
“We have received positive feedback from most hospitals attending the session and we are looking forward to faster integration and implementation of the portal across the hospitals in Bengal.”
The portal, though in a nascent stage, is ready. At Monday’s meeting, the hospitals were shown how to register with the portal. Sources said the insurance companies and major TPAs have already been integrated on the portal.
According to sources, five big private hospitals in Calcutta have been chosen for initial registration and the others will follow.
“We are extremely happy about the portal and will register soon. It will reduce the time for sending details of patients to the TPAs and insurance companies and make the entire exercise simpler,” said Pradip Tondon, CEO of Belle Vue Clinic who attended the meeting.
Hospitals now have to send documents to TPAs and insurance companies separately and that takes a lot of time.
In the new system, as soon as a patient with a cashless health insurance policy is admitted, the documents will be uploaded on the portal so the insurer and the TPA can access them at the same time.
The approvals, too, will be given through the portal and the hospital can see them real-time.
“This will help in the long run for the IRDAI to monitor delays in processing claims. The portal should be beneficial for the patients,” said Sudipta Mitra, chief executive, Peerless Hospital.
However, an official of an insurance company pointed out that the portal will help cut delay in patients’ leaving for home after being discharged only when everything else is in place.
“Hospitals will have toprocess the documents on time and TPAs and insurance companies have to give approvals on time. Only then,the portal can be of real helpto the patients,” said theofficial.
“The doctors should be urged to sign discharge papers a day before the discharge so the documentation is done early. Also, many TPAs do not have enough personnel and that cause delays in processing claims and issuing approval,” the official said.
