Bengaluru, 10 July 2024: HDFC ERGO General Insurance Company, India’s leading private sector general insurer, successfully processed its first-ever health claim through the National Health Claims Exchange (NHCX) platform. This groundbreaking achievement marks a significant leap forward, which will help streamline health claims processing, improve administrative efficiencies, and enhance customer experience by building a cohesive technology-driven system.

Based on the directive from the Insurance Regulatory and Development Authority of India (IRDAI), the General Insurance Council has been working on bringing the various stakeholders together to ensure the entire process of health Insurance is done in a more simplified and transparent manner.

Developed by the National Health Authority (NHA), the NHCX platform is a single-window interface that provides a secure and efficient exchange of health insurance claims data. The platform is poised to revolutionize India’s health insurance landscape by setting a new standard for efficiency and transparency in claims processing.

As a digital health claims portal, the National Health Claims Exchange (NHCX) is a significant leap towards ensuring interoperability of health claims and fostering transparency within the industry. HDFC ERGO becomes one of the lead insurers to process health claims on NHCX platform. This marks a significant step forward in India’s health insurance landscape and attests to the commitment of the Company to propelling financial inclusion in India

Parthanil Ghosh, Director and Chief Business Officer, HDFC ERGO General Insurance, said, “In alignment with IRDAI’s vision of ‘Insurance for All by 2047’, we are committed to providing innovative solutions thereby making insurance accessible and affordable and continue to work towards improving insurance penetration across the country. In alignment with the Government’s flagship ‘Ayushman Bharat Digital Mission’, we are proud to successfully process our first health claim through the NHCX platform. This further underscores our commitment to leverage cutting-edge technology and bring in better transparency and claims efficiency in health insurance. As a crucial stakeholder in building a ‘Healthy India, we are confident that the NHCX platform will play a significant role by ensuring the interoperability of health claims, democratizing insurance, and fostering transparency within the industry.”

The NHCX is a critical gateway for exchanging claims-related information within the healthcare and insurance ecosystem. It is designed to streamline and enhance health insurance claims processing by integrating insurers, healthcare providers, and policyholders into a cohesive, technology-driven system. This platform leverages advanced digital technologies to ensure efficient, transparent, and expedited claims settlements, thereby improving the overall health insurance ecosystem.

The process begins with the hospital generating a bill through its Hospital Information System (HIS), which is then uploaded to a Third-Party Administrator (TPA) app. The Health Claim System (HCS) of HDFC ERGO then processes the claims in their claim processing queue.

As a customer experience-focused organization, HDFC ERGO is continuously disrupting technologies to offer hyper-personalized services to build a fair and robust claims management system. Being a multi-channel organization, the company offers a host of options and customers can check their claim status via a 24X7 contact center, dedicated customer service email, WhatsApp, website, email, customer service app, etc. Policyholders can also track the status of their claims on a real-time basis through the Here app, a one-of-a-kind insurer-led ecosystem, or simply through the bitly links which are sent to them as soon as they register any claim. With a 100% claim settlement ratio in health insurance, the company’s average time to settle a cashless health claim is less than 40 minutes. These moves indicate a shift towards the HDFC ERGO’s digital-first customer service as 70%+ health claims are now being intimated digitally, resulting in swift claim processing.