The National Health Authority (NHA) invites contributors and developers from the open community, especially those working in the Health Insurance and Healthcare Provider space to test, contribute and become a participant in the Health Claims Exchange Ecosystem by onboarding on the HCX – Sandbox Environment. NHA announced HCX as a new initiative under the Ayushman Bharat Digital Mission (ABDM) on 23rd September 2022 and subsequently worked with various groups to come up with Health Insurance Exchange specifications.

The current health insurance claims settlement process in the country is mostly manual, non-digital and laborious in nature posing challenges at every stage. The current process of exchanging claims lacks standardization across the ecosystem with most data exchange occurring through PDF/manual methods and processes vary significantly among Insurers, TPAs, and Providers leading to high cost of processing each claim.

To tackle these key challenges and streamline the process of claim settlement, NHA has developed a national Health Claims Exchange (HCX) to enable interoperability of health claims. The HCX serves as a protocol for exchanging claims-related information among various actors, including payers, providers, beneficiaries, regulators, and observers. It is designed to be interoperable, machine-readable, auditable, and verifiable which helps ensure that the information being exchanged is accurate and trustworthy. HCX will act as a gateway (with validation and routing capabilities) for the ecosystem wherein the Insurers/ TPAs shall send responses for each FHIR based e-claim submitted by providers via the HCX through standard protocols (APIs).

With a vision to standardize the claims process, HCX will lead to reduction in operational overheads and increase the trust among payers and providers through a transparent and rule-based mechanism, it will reduce claims processing cost, expedite pre-authorization or patient discharge approvals, improve patient experience, better visibility for tracking the claims and have better quality data for industry and regulators.

To ensure the success and adoption of the claims network, it is essential to onboard participants on the HCX ecosystem, therefore it is requested that all interested solution providers, payers, and provider to actively participate and utilize the services of the HCX – Sandbox, the key goal of the sandbox is to help the ecosystem test its specific components against the communication standards and get certified to become a part of the system. Once a participant successfully completes the sandbox process, they can use the certification to get onboarded to the HCX production environment with the necessary access.

The interested participants can submit an online application to express their interest to access the HCX sandbox on https://sbxhcx.abdm.gov.in/. On successful verification, the approved participants are added to the HCX sandbox and provisioned with the necessary credentials to access the sandbox environment. The link also provides all necessary documentation for participation along with the HCX specifications and FHIR profiles.

The FHIR Implementation Guide (IG) for ABDM has been updated to support HCX specifications. The preview of the IG is hosted at - https://www.nrces.in/preview/ndhm/fhir/r4/hcx-profile.html.