Health Claims Platform like Stock Exchange under Ayushman Bharat: On the lines of electronic stock exchanges like NSE and BSE, the IRDAI and National Health Authority (NHA) wants to set up a national Health Claims Platform (HCP).
Health Claims Platform like Stock Exchange under Ayushman Bharat: On the lines of electronic stock exchanges like NSE and BSE, the IRDAI and National Health Authority (NHA) wants to set up a national Health Claims Platform (HCP). A Joint Working Group (JWG) of the Insurance Regulatory Development Authority of India (IRDAI) and NHA has recommended the creation of the HCP as a “public good” where the health providers can submit e-Claims and the payers (insurers and Third Party Administrators) can receive e-claims via standard API.
Arguing for the creation of HCP, the JWG report said, “The electronic stock exchange ushered in an era of trusted paperless trading and guaranteed delivery of money to all stakeholders, bringing with it an exponential increase in volumes. The health claims industry requires a similar enabling solution to foster trust in the Health ecosystem of the nation, and support and encourage a growth in claims across many kinds of care.”
The setting up of health claims platform would be a big step in pushing the health insurance sector to a completely paperless ecosystem. Going paperless is necessary, especially at a time when the number of health insurance claims in the country is expected to grow exponentially over the next few years because of Ayushman Bharat (PMJAY) and the growing health insurance coverage provided by insurers. Under Ayushman Bharat – PMJAY alone, there are around 50 crore beneficiaries.
Health Claims Platform: Functions
The JWG report, which was launched for the consideration of general public, experts and other stakeholders on Saturday last, said the “HCP will provide a set of digital services that will ensure the industry can move to common standards for claim processing. HCPs will enable new innovative software for both payers and providers to perform more efficient and timely claims management.”
The JWG has also recommended to introduce Health Claims Platform providers (HCPP) who will provide the “standardized digital services needed by the ecosystem.”
The HCP will be a “mission critical software” on which “both payers and providers will rely on, and the multi-provider model” would encourage competition and will be “failsafe” for users.
The HCP software providers would be expected to charge per claim to both payers and providers for the digital services they will offer, the report recommended.
NHA is responsible for design, roll- out, implementation and management of Ayushman Bharat – PMJAY.