National Health Claim Exchange (HCX)

The National Health Claim Exchange (HCX) is a transformative platform designed to streamline and optimize health claims processing. Learn how HCX can benefit healthcare providers and patients.
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3 min
09-December-2025

The National Health Claims Exchange operates similarly to internet and email exchange networks by enabling the transfer of data packets from one point to another. Just as routing switches or email gateways ensure messages are sent and received with consistency, security, privacy, and durability, the National Health Claims Exchange acts as a protocol for exchanging health insurance claims-related information among various stakeholders, including payers, providers, beneficiaries, regulators, and observers.

What is the National Health Claim Exchange (HCX)?

The Health Claim Exchange Specification is a communication protocol that enables the exchange of health claim information among payers, providers, beneficiaries, and other relevant entities. Designed to be interoperable, machine-readable, auditable, and verifiable, it ensures that the exchanged information is accurate and trustworthy. This specification is based on an open standard communication framework.

Features of the NHCE

  • Upgrading Efficiency and speed

  • Improving Data Accuracy

  • Facilitation of Care Coordination

  • Reduction in cost

  • Enhancing Accountability and Transparency

  • Compliance with Regulatory Requirements

The objective of a NHCE is to simplify insurance claims and, for instance, it makes senior citizen health insurance claims easier for senior citizens in times of hospitalisation due to critical illness.

Objectives of the National Health Claims Exchange (NHCX)

Discussed below are the key objections of National Health Claim Exchange (NHCX):

  • Introduce new types of claims in insurance policies to expand coverage, including OPD and pharmacy bills.
  • Shorten receivable cycles and boost acceptance of cashless claims, even in smaller hospitals.
  • Enable innovation in insurance by implementing new processes and rules for automated adjudication and fraud prevention.
  • Standardise the claims process to cut operational costs and enhance trust between payers and providers through transparency and rule-based mechanisms.
  • Enhance the patient experience through these improvements.

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Solutions to ease claim settlement with HCX

Addressing challenges within the current claims process aligns with the solutions provided by HCX. Presently, health insurance claims management faces inefficiencies, high costs, and standardisation issues. To address these, HCX aims to improve operational efficiency, reduce costs, and enhance transparency—factors that can significantly influence the claim settlement ratio in health insurance, ensuring faster and more reliable claim outcomes for policyholders.

  • Tackle the lack of standardisation: Different rules from healthcare providers and insurers create a cumbersome claims experience. HCX achieves standardisation through its platform, streamlining communication and procedures.
  • Combat inefficiencies and high costs: Manual methods in the non-standardised, non-digital process lead to delays and increased operational expenses per claim. HCX's digital platform ensures real-time updates on claim status, reducing operational overheads.
  • Automate manual processes: Despite technological advancements in healthcare, outdated methods persist. HCX's digital implementation enables real-time updates on claim status, replacing manual processes with efficient digital solutions.

HCX and Ayushman Bharat Digital Mission

HCX is more than just a digital platform; it's a community-driven initiative aligned with the Ayushman Bharat Digital Mission. Spearheaded by the National Health Authority, this program aims to achieve universal health coverage by facilitating HCX data exchange, ensuring a seamless experience.

  • HCX operates on an open-source protocol, enabling contributions from global healthcare experts.
  • Collaboration fosters transparency and adaptability, making HCX a versatile platform.
  • The Ayushman Bharat Digital Mission holds significant importance for HCX.
  • Its goal is to enhance public health insurance coverage by minimising fraud and streamlining claims handling.
  • HCX strictly adheres to data privacy and security standards.
  • Utilising advanced encryption and blockchain technology, HCX ensures data integrity and confidentiality.
  • Currently undergoing a sandbox process, it undergoes rigorous testing before transitioning to a production environment.

Benefits of the National Health Claim Exchange (NHCX)

HCX addresses key pain points in today’s health insurance claims ecosystem, transforming how stakeholders interact across the healthcare value chain. It represents a significant step forward for India’s health benefits infrastructure.

  • Seamless interoperability and data exchange: HCX enables smooth, standardised exchange of health claims data across stakeholders. With access to electronic health records, healthcare providers can view a patient’s complete medical and insurance information in one place. This reduces errors, improves coordination, and enhances the overall patient experience.

  • Faster and more efficient claim settlements: From pre-authorisation to discharge approvals, HCX automates critical steps in the claims lifecycle. By minimising manual interventions and paperwork, hospitals benefit from quicker settlements and improved bed turnover driven by faster reimbursements.

  • Enhanced patient experience and cost efficiency: HCX offers real-time visibility into claim status, reducing uncertainty for patients. By lowering administrative overheads, the platform brings down the cost per claim—savings that ultimately translate into more affordable care for patients.

  • Greater transparency across stakeholders: HCX introduces end-to-end transparency by providing a single, unified view of claims. Patients, hospitals, and insurers can easily track claim progress, payment status, and related details—eliminating confusion and delays.

  • Robust data security and privacy: Protecting sensitive health information is central to HCX. The platform uses strong encryption and strict access controls to ensure that personal and medical data remains secure and accessible only to authorised parties.

  • Quicker reimbursements: By eliminating manual processing and communication gaps, HCX accelerates reimbursement timelines. Patients receive their claim payouts faster, improving financial predictability during medical care.

  • Advanced fraud detection: HCX leverages analytics and machine learning to identify irregular claim patterns. This proactive approach helps detect and prevent fraud, reducing financial leakage and maintaining system integrity.

  • Improved healthcare outcomes: With timely access to comprehensive patient data—such as medical history, allergies, and previous treatments—healthcare providers can make better-informed clinical decisions, resulting in more accurate diagnoses and personalised care.

  • Higher patient engagement: HCX empowers patients by giving them direct access to health records, claim status updates, and communication channels with insurers and providers. Greater transparency and control encourage proactive health management and better adherence to treatment plans.

  • Data-driven decision-making: HCX generates rich, actionable data across the healthcare ecosystem. Providers can identify patterns to optimise care delivery, insurers can design more efficient and personalised products, and policymakers can use aggregated insights to address public health priorities.

Challenges with current claim process

Addressing challenges within the current claim process and providing solutions:

  • Automation and digitisation:
    Manual claim processing is time-consuming and prone to errors. Digitisation streamlines workflows, reduces human error, and accelerates claim processing.
  • Standardisation:
    Inconsistent claim formats cause confusion and delays. Establishing standardised protocols for claim submission, documentation, and coding ensures consistency and simplifies the process.
  • Transparency and communication:
    Inefficient communication and lack of transparency lead to disputes. HCX fosters openness in the claim process, enhancing communication and transparency among stakeholders.
  • High cost and inefficiency:
    The current manual claim system is costly and inefficient. HCX introduces cost reduction and efficiency through digitalisation and streamlined processes.

The future of health insurance with HCX

The integration of HCX into the health insurance ecosystem marks a pivotal shift toward a more efficient, transparent, and technology-driven future. By standardising and digitising claims infrastructure, HCX has the potential to redefine how health insurance operates in the years ahead.

  • Seamless and faster claims processing: HCX streamlines the entire claims journey by automating and standardising workflows. This reduces administrative effort, minimises delays, and significantly accelerates claim assessment and settlement.

  • Advanced and connected data exchange: HCX enables smooth, real-time data exchange among insurers, healthcare providers, and other ecosystem participants. This interconnected framework reduces information silos and enables better coordination across the care continuum.

  • Higher accuracy and stronger fraud prevention: With the use of advanced analytics and intelligent systems, HCX improves the accuracy of claims evaluation while strengthening the detection and prevention of fraudulent or anomalous claims.

  • Personalised care and proactive risk management: Through deeper insights derived from claims data, HCX allows insurers to identify high-risk cases early and design targeted, personalised care management programmes—shifting the focus from reactive to preventive healthcare.

  • Greater transparency and consumer empowerment: HCX enhances trust by giving policyholders clear visibility into their claims information. Greater transparency enables consumers to track progress, understand outcomes, and actively participate in their healthcare and insurance decisions.

How HCX aims to transform the healthcare sector in India?

HCX, a digital claims platform, is poised to revolutionize the insurance and re-insurance sectors by assuming a regulatory role. Here's a breakdown of its key features and impacts:

  • Unified platform: HCX brings together diverse stakeholders, including policyholders and healthcare providers, onto a single platform. This consolidation simplifies the sharing of health claims information, fostering a streamlined claims network.
  • Enhanced transparency: Through HCX, policyholders gain greater control and access to real-time information, facilitating informed decision-making. This transparency promotes trust and accountability within the insurance ecosystem.
  • Efficiency and cost savings: HCX promises a more efficient process for all stakeholders. Policyholders benefit from improved decision-making with access to real-time data, while healthcare providers can redirect resources from administrative tasks to patient care, thanks to lower overhead costs.
  • Regulatory compliance: As HCX transitions from a sandbox environment to production, it commits to adhering to regulations set by the National Health Authority. This ensures compliance with data privacy and security standards, safeguarding sensitive information exchanged on the platform.
  • Standardisation and quality assurance: HCX's regulatory role extends to standardising processes and ensuring quality assurance across the insurance and re-insurance sectors. By setting and upholding industry standards, HCX fosters a more robust and reliable ecosystem for all stakeholders involved.

In response to these challenges, HCX initiatives give top priority to deploying robust measures for preventing fraud and enhancing security protocols. Additionally, HCX implements stringent security measures to safeguard the confidentiality of sensitive health information exchanged through its systems.

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Frequently asked questions

What is the primary purpose of HCX, the National Health Claim Exchange?
The primary purpose of HCX, the National Health Claim Exchange, is to streamline the health claims process by uniting stakeholders, enhancing transparency, improving efficiency, and ensuring data security and privacy within the insurance and re-insurance sectors.
How does HCX improve the efficiency of health claims processing?
HCX improves health claims processing efficiency by unifying stakeholders on one platform, providing real-time data access, reducing administrative overheads for healthcare providers, and implementing robust fraud prevention and security measures, resulting in faster, more transparent claims management.
What are the key features of HCX that benefit healthcare providers?
HCX benefits healthcare providers with streamlined claims processing, reduced administrative overheads, real-time data access for informed decision-making, robust fraud prevention measures, and stringent security protocols to protect sensitive health information, allowing more focus on patient care.
Why is the Health Claims Exchange useful?

The Health Claims Exchange simplifies and speeds up the health insurance claims process. It enables seamless data sharing between insurers, hospitals, and other stakeholders, reducing paperwork, minimising errors, and improving claim transparency. For patients, this means faster approvals, real-time claim updates, and a smoother overall experience.

How does the NHCX work?

NHCX functions as a digital bridge between insurers, healthcare providers, and third-party administrators. It standardises claim-related data and enables secure, real-time exchange of information across authorised entities. By automating workflows such as pre-authorisation and claim settlement, NHCX reduces delays and improves efficiency.

How to register on NHCX?

Registration on NHCX is typically done by healthcare providers, insurers, and authorised intermediaries through designated onboarding processes defined by IRDAI. Patients do not need to register separately, as their claims are processed through participating hospitals and insurers within the NHCX network.

Who launched the National Health Claims Exchange?

The National Health Claims Exchange was conceptualised and launched under the guidance of the Insurance Regulatory and Development Authority of India (IRDAI) as part of India’s broader digital health and insurance modernisation efforts.

What is the National Health Claims Exchange by IRDAI?

The National Health Claims Exchange (NHCX) is a digital platform introduced by IRDAI to standardise, automate, and streamline health insurance claims in India. It enables secure data exchange across insurers, hospitals, and third-party administrators, improving transparency, efficiency, and policyholder experience.

What expenses are covered under health insurance?

Health insurance typically covers expenses related to hospitalisation, including room rent, doctor’s fees, diagnostic tests, medicines, surgeries, and pre- and post-hospitalisation costs. Coverage varies by policy, and may also include day-care procedures, ambulance charges, and certain preventive care benefits, subject to policy terms and conditions.

Why is the Health Claims Exchange useful?

The Health Claims Exchange simplifies and speeds up the health insurance claims process. It enables seamless data sharing between insurers, hospitals, and other stakeholders, reducing paperwork, minimising errors, and improving claim transparency. For patients, this means faster approvals, real-time claim updates, and a smoother overall experience.

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