NHA & IRDAI Host Workshop for Insurers & TPAs on ABDM & NHCX Integration

The central aim of the workshop was to enable a smooth integration process for insurance companies into the Ayushman Bharat Digital Mission (ABDM) and to promote the acceptance of Health Claims Exchange (HCX) specifications and e-Claim standards.

In a move towards enhancing digital integration within the health insurance sector, the National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) have jointly conducted an exclusive three-day Accelerator Workshop.

The primary objective of the workshop was to facilitate the seamless integration of insurance companies with the Ayushman Bharat Digital Mission (ABDM) and the adoption of Health Claims Exchange (HCX) specifications and e-Claim standards.

The workshop, held from the 10th to the 12th of August 2023 in New Delhi, witnessed active participation from over 150 industry professionals representing 29 insurance companies and 16 Third-Party Administrators (TPAs). This collaborative initiative aimed to strengthen the foundation of digital healthcare and insurance services.

The IRDAI took a pivotal step in June 2023 when it issued a circular urging all insurance companies to collect and integrate Ayushman Bharat Health Account (ABHA) numbers for individuals seeking insurance coverage.

Furthermore, insurers were advised to obtain consent from policyholders for sharing medical records through the ABHA platform. The ABHA number serves as a unique identifier in the digital landscape, and fosters streamlined healthcare and insurance service delivery. By granting insurers secure access to medical information in a paperless manner, this initiative expedites the claims process and provides policyholders with transparent and efficient service.

Additionally, the IRDAI released circular advising insurance entities to join the National Health Claims Exchange (NHCX). This exchange serves as a conduit for the exchange of claims-related information among stakeholders within the healthcare and health insurance ecosystem.

This encompassing platform facilitates communication between insurers, TPAs, claimants, beneficiaries, and healthcare providers. Integration with the NHCX promotes seamless interoperability in health claims processing, further streamlining the insurance landscape.

The joint efforts of the NHA, IRDAI, and relevant stakeholders bore fruit as 29 entities, including 23 insurance companies and 6 TPAs, successfully completed the first level (M1) of ABDM integration. This achievement enabled them to create and validate ABHA numbers. Notably, 20 insurance companies also triumphantly concluded Level 1.2 of their NHCX integration, which allows the linkage or delinking of ABHA with insurance policies.

The successful completion of the integrations was possible through technical support provided by the NHA and CDAC, Pune, who assisted representatives from insurance companies and TPAs. Notably, the General Insurance Council (GIC) played a crucial role in bringing together teams from leading insurers and providers for the workshop.

The Ayushman Bharat Digital Mission (ABDM) focuses on integrating Ayushman Bharat Health Account (ABHA) numbers, streamlining healthcare and insurance services through digital identification.

The National Health Claims Exchange (NHCX) serves as a platform for stakeholders in healthcare and insurance to exchange claims-related information seamlessly, promoting efficient processing and communication among insurers, TPAs, claimants, beneficiaries, and healthcare providers.