Health Claims Exchange
Health Claims
Exchange
Specifications
To read further about the
Specifications
Specifications
Background
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
Source:
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.
Overview
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
related experience

Faster claims
processing

Better visibility and
tracking of claims

Newer innovative
insurance products

Reduction in claims
processing cost

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
Partner Organizations
Hospitals







Insurers












HMIS/Claims Platforms/InsureTech









TPAs


Think Tanks




Associations


Community Health



For more information, reach us on
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.
Consultation timeline:
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.