The National Health Claims Exchange (NHCX) is a concept and a standardized digital gateway designed to streamline health insurance claims processing in India. It was developed under the Ayushman Bharat Digital Mission (ABDM) by the National Health Authority (NHA) in consultation with the Insurance Regulatory and Development Authority of India (IRDAI). The NHCX was created to solve the problem of the existing claims settlement process, which was predominantly manual, non-digital, and labor-intensive, leading to significant delays and errors for all stakeholders. It went live in June 2024, replacing the previous system of multiple, insurer-specific portals and manually exchanged documents.
The NHCX functions as a single national gateway and a standardized communication protocol that securely routes claims information between healthcare providers (hospitals) and payers (insurers, Third-Party Administrators, and government schemes). It is a router, not a repository, meaning it moves claims data but does not store patients' clinical or financial records, which are encrypted end-to-end. The mechanism standardizes core claims workflows, including eligibility checks, pre-authorization, claim submission, and reconciliation. This standardization is achieved by leveraging the Fast Healthcare Interoperability Resources (FHIR) standards to ensure interoperability across diverse systems. The NHCX is a key component of the ABDM stack, and every claim processed through it is anchored to the patient's ABHA number (Ayushman Bharat Health Account). The change is a shift from uncoded data and manual processes to a single, efficient digital rail, similar to the transformation brought by UPI in payments.