National Health Claims Exchange (HCX)-Sandbox

The National Health Authority has invited participation in the National Health Claims Exchange (HCX)-Sandbox recently under the Ayushman Bharat Digital Mission (ABDM).

About HCX

The Health Claims Exchange (HCX) is a new initiative under the Ayushman Bharat Digital Mission (ABDM) that aims to bring interoperability of health claims and streamline the process of claim settlement. The HCX was announced by the National Health Authority (NHA) on September 23rd, 2022, as a solution to the challenges posed by the current manual and non-digital process of exchanging health insurance claims in the country.

Features of HCX

The HCX is designed to be interoperable, machine-readable, auditable, and verifiable, ensuring that the information being exchanged is accurate and trustworthy. Insurers and third-party administrators (TPAs) are required to send responses for each e-claim submitted by providers via the HCX through standard protocols (APIs). The HCX acts as a gateway for the ecosystem, validating and routing the responses.

Benefits of HCX

The HCX is expected to lead to a reduction in operational overheads and increase trust among payers and providers through a transparent and rule-based mechanism. It will reduce claims processing costs, expedite pre-authorization or patient discharge approvals, improve patient experience, better track claims, and provide better quality data for industry and regulators.

HCX – Sandbox Environment

To ensure the success and adoption of the claims network, the NHA has introduced the HCX – Sandbox Environment. This is a testing ground for contributors and developers from the open community, especially those working in the Health Insurance and Healthcare Provider space, to test and contribute to the HCX ecosystem. The HCX – Sandbox enables participants to test their specific components against communication standards and get certified to become a part of the system. The successful completion of the HCX – Sandbox process enables the participants to gain access to the HCX production environment.



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