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About National Health Claim Exchange (NHCX)

Context:

The National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) have joined hands to operationalize the National Health Claim Exchange (NHCX).

Relevance:

GS II: Health

Dimensions of the Article:

  1. National Health Claim Exchange (NHCX)
  2. National Health Authority (NHA)

National Health Claim Exchange (NHCX):

Development and Purpose:

  • Digital health claims platform developed by the National Health Authority.
  • Serves as a gateway for exchanging claims-related information among stakeholders in the healthcare and health insurance ecosystem.

Key Features:

  • Designed to be interoperable, ensuring compatibility with various systems.
  • Machine-readable for efficient data processing.
  • Auditable and verifiable to maintain accuracy and trustworthiness of exchanged information.

National Health Authority (NHA):

  • Responsibilities:
    • Apex body implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
    • Tasked with designing strategy, building technological infrastructure, and implementing the “National Digital Health Mission” to create a National Digital Health Eco-system.
  • Evolution and Autonomy:
    • Successor of the National Health Agency, reconstituted as the National Health Authority in January 2019.
    • Originally functioned as a registered society and transitioned to full functional autonomy.
  • Structure and Governance:
    • Attached office of the Ministry of Health and Family Welfare.
    • Governed by a Governing Board chaired by the Union Minister for Health and Family Welfare.
    • Headed by a Chief Executive Officer (CEO), holding the rank of Secretary to the Government of India.
    • CEO serves as the Ex-Officio Member Secretary of the Governing Board.
  • State-Level Implementation:
    • Implementation at the State level involves the establishment of State Health Agencies (SHAs) as societies/trusts.
    • SHAs are set up by respective States to execute the scheme locally.

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