Page 14 - Insurance Times July 2024

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body responsible for implementing the
Discharge delays may slow claims move from Ayushman Bharat PM Jan Aarogya

IRDAI Yojana, and the IRDAI. "IRDAI will con-
tinue to regulate the insurance indus-
The insurance regulator's recent rule changes to make life easier for policy-
try. We are not going to get into that.
holders will likely require a sectorial overhaul before patients are able to
get discharged from hospitals faster. The health ministry's motive behind
developing NHCX is only to act as a
While insurance industry experts pin the blame on hospitals for slow pro- facilitator for faster and more trans-
cessing of claims, a lot of the delays in clearing claims from patients admit- parent processing of health insurance
ted in hospitals also stem from procedural hiccups. claims," said a senior official.
A new digital information sharing platform still in the discussion stage and
an increased role for technology platforms might, however, help the regu- In Madurai, health cover
lator achieve its ambition of ensuring that patients cleared for discharge
aren't held back because of protracted processing. to cost 40% less than
Mumbai
Health cover claims to ment provide their insurance policy Star Health, which pioneered health
details or a card issued by the third-
soon be processed via insurance in the country, is using data
party administrator (TPA) or insurance it has collected over 18 years to offer
NHCX platform company. The hospital then accesses differentiated pricing based on custom-
Soon, all health insurance claims will the claim processing portal of the com- ers' location. It is also exploring new
be processed by hospitals and insur- pany and uploads the required docu- products that are either location-spe-
ance companies through a single win- ments for pre-authorisation or claim cific or network-specific.
dow - the National Health Claims Ex- approval. On receipt of the pre-
change (NHCX). Health ministry authorisation/claim form, the insur- Star Health MD & CEO Anand Roy,
sources told the NHCX, developed by ance company/TPA authenticates and that a customer in Madurai will pay 30-
the National Health Authority (NHA), digitises the form using its internal 40% less for a product than someone
is ready and under trial at present. claims processing portal. The claim is in Mumbai.
"NHCX will have a standardised format then adjudicated by the relevant "Our experience over the last 18 years
to be followed by insurance companies team. These data exchanges often in- is that customers in different cities have
to process claims," said a source. volve PDF/manual paperwork which different expectations. We know ex-
Currently, most insurance companies adds to the processing time and in- actly what is the right price for some-
offering health coverage have their creases the risk of errors. body living in a tier III city versus some-
own platforms and processes to ap- Officials in the health ministry said one in a metro," said Roy.
prove claims. NHCX is the result of a collaborative According to him, regulations intro-
Patients who visit a hospital for treat- effort between the NHA, the apex duced by the insurance regulator in

The Insurance Times July 2024 13