National Health Claims ExchangeIndia’s Unified Platform for
Claim Settlement

Leveraging cross platform interoperability NHCX enables seamless data exchange between Payers and Providers in completely digitized format

View Docs

NHCX Statistics Private and Govt

Integrators
3846
Hospitals
86346,896
Pre auth
151,939161,119,596
Claims
28,60987,304,082

NHCX for every Hospital, every Insurance company, every Insurance scheme. Embrace the future in cashless claims settlement, save on time, cost and efforts.

Standardisation
One standard for every claim

Every claim speaks the same language

NHCX uses FHIR-based standards and internationally accepted coding practices, so provider and payer systems can exchange health information in a common, machine-readable format, without losing its meaning across systems.

  • One common structureHealth information follows a consistent FHIR-based format.
  • Zero ambiguityStandardised codes preserve the meaning of clinical information.
  • Works across systemsDifferent technology stacks exchange the same information.
Structured data
Send data, not documents

Data a system can read, not a page to re-type

Diagnoses, procedures, drugs and bill lines travel as coded values: priced and checked automatically instead of opened and read.

  • Coded at source
  • Nothing lost in transit
  • Signed and audit-ready
Automation & AI assistance
More accuracy, less resistance

Fewer queries, faster decisions

Validated claims in line with Payer expectations; reducing gaps in communication leading to quick and accurate adjudication.

  • Fair and transparent cycles
  • Minimal query and rejection
  • Lower TAT, better patient care and reap the benefits of NHCX

How NHCX works

Idea is to transmit the health information that is already generated by a Provider hospital in digitized format to an Insurer without losing any of its essence, and that too in a protocol standard set by the Payer beforehand.

View Docs →

How a typical flow looks like

01 · HMIS / LMIS / RIS / EMR
Patient Records

Clinical Notes, Treatment Plan, Procedure Details, Diagnostic Reports, Discharge Summary and Itemized Bill sent to Payer addressee.

02 · In Transit
Schema checked and validated

The structured information enters pipeline as an encrypted payload in FHIR R4 format with due digital authorization from both sender and receiver.

03 · NHCX Gateway
Record transaction and Deliver

NHCX maintains log of transaction about sender and receiver from Participant IDs and the purpose of the transaction from Workflow ID and forwards to the Beneficiary.

04 · Payer Engine
Claim Processing

Payer matches the data received against its existing records and adjudicates the claim easily based on the every minute details made available.

05 · The Response
Communication of Decision

The return leg follows the same sets of protocol in the reverse direction with Provider receiving a callback.

How a typical flow looks like

  1. 01 · HMIS / LMIS / RIS / EMR
    Patient Records

    Clinical Notes, Treatment Plan, Procedure Details, Diagnostic Reports, Discharge Summary and Itemized Bill sent to Payer addressee.

  2. 02 · In Transit
    Schema checked and validated

    The structured information enters pipeline as an encrypted payload in FHIR R4 format with due digital authorization from both sender and receiver.

  3. 03 · NHCX Gateway
    Record transaction and Deliver

    NHCX maintains log of transaction about sender and receiver from Participant IDs and the purpose of the transaction from Workflow ID and forwards to the Beneficiary.

  4. 04 · Payer Engine
    Claim Processing

    Payer matches the data received against its existing records and adjudicates the claim easily based on the every minute details made available.

  5. 05 · The Response
    Communication of Decision

    The return leg follows the same sets of protocol in the reverse direction with Provider receiving a callback.

Your NHCX Integration now made easy with AI

Make the best use of an omnipotent AI Tool that understands the entire communication protocol, FHIR bundles, flow wise use cases and probable errors, besides generating codes for you.

Integrators’ journey from Registration to Production

All it takes for a new Integrator from ABDM registration to settle claims on NHCX - embark on the journey, build and test in Sandbox, validate and demonstrate… then Go Live

  1. Complete you ABDM milestones

    ABDM milestone M1 is a prerequisite before starting your NHCX integration and gaining API access, for Payer and Provider roles; whereas for Providers both M1 and M2 are recommended.

    Sandbox Registration
    • ABDM Sandbox
    • Milestone M1
    • Milestone M2

  2. Develop and Test in Sandbox

    Apply for the NHCX Sandbox with the intended role and integrate with your application against the published APIs and FHIR profiles. Test the end to end claims journey including insurance plan, coverage eligibility, pre-authorisation, claims and payment communication using the sandbox environment.

    HCX Sandbox Documents
    • Sandbox APIs
    • FHIR profiles
    • Eligibility
    • Pre-authorisation
    • Claims
    • Payment

  3. FHIR Validation and UAT

    Proceed with the required functional test cases for NHCX workflows and validation of your FHIR payloads. Demonstrate the working capabilities for individual use cases during UAT post integration in order to establish your production readiness.

    Test Cases
    • Functional test cases
    • FHIR validation
    • Review and demo

  4. HTC Demo and Go Live

    Receive role based Production access for NHCX on your Client ID already assigned to you after ABDM M1 certification. Configure your Participant ID along with credentials to establish connect with NHCX gateway and thus start processing claims.

    Sandbox Registration
    • Production access
    • Participant credentials
    • Live claims

See whats happeningDevTools

Dev Environment

Build, validate and test NHCX integrations safely before connecting to production.

SANDBOX

Reference Payer & Provider

Simulate both sides of a claim exchange to test complete NHCX workflows end to end.

PROVIDERPAYERclaim.submitclaim.response

Documentation

Find implementation guides, API specifications and technical references for building on NHCX.

DOCSOPENAPISNIPPETSBUILDAPPNHCX COMPLIANT

NHCX Adapter (Optional)

Connect existing hospital or payer systems to NHCX without rebuilding your core workflows.

HMISPAYERNHCXORADAPTER

NHCX Benefits

Independent exchange between Providers and Payers.

40K+
Hospitals served
Open
Standards based

FAQ

  • NHCX (National Health Claims Exchange) is a platform developed under the Ayushman Bharat Digital Mission (ABDM) to streamline and standardise the exchange of health-claim information between healthcare providers and payers. It enables digitised, machine-readable information to move between different systems using common standards.

    Learn More →
See More

Build in the Sandbox. Certify Once. Go Live

Free to test and certify for Hospitals, Insurer, TPA’s, Government schemes and solutoin vendors

Get Started →