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The current health claims settlement process is manual and time-consuming, presenting challenges at each stage
- Health Claims Exchange Volunteers
- Insurers & TPAs need to digitise uncoded data themselves, relying on manual adjudication, & limited fraud analytics
- Regulators receive delayed & incomplete data
- Patients bear with long waiting periods, minimal communication & transparency
The IRDAI-NHA Joint Working Group recommended creation and adoption of a Health Claims Platform and standardization of e-Claims and other related documents to enable the ecosystem to move to a low cost paperless regime that allows for innovation. To build this, the first step needed was the creation of open claims standards.
Inspired by recommendations of the Joint Working Group of NHA and IRDAI (2019), these standards have been developed by 80+ volunteers from across the healthcare ecosystem (including Insurers, Hospitals, TPAs, Insurance Technology players and Think tanks), as part of a transparent, collaborative and open effort anchored by Swasth.
Health Claims Exchange for Cashless Insurance
Benefits of Health Claims Exchange
Improved patients’ claim
Better visibility and
tracking of claims
Reduction in claims
Better quality data for the
industry and regulators
Health Claims Exchange Specifications
For Cashless Insurance
Benefits of Health Claims Exchange Specifications
Improved patients’ claim related experience
Better visibility and tracking of claims
Reduction in claims processing cost
Faster claims processing
Newer innovative insurance products
Better quality data for the industry and regulators
Public Consultation of Health Claims Exchange
Specifications for Cashless Health Insurance
Purpose of the consultation:
The key objective of the consultation is to elicit feedback from the industry and the public on the Health Claims Exchange Specifications for Cashless Insurance to ensure that these specifications can eventually be accepted and adopted.
Please submit your inputs by October 08, 2021.
Process to be followed post consultation deadline:
All the consultation inputs will be available publicly. All the inputs received will be reviewed by the Health Claims Exchange Specifications Governance Committee at Swasth and adopted as appropriate. A post consultation report will be published by Swasth based on feedback received.