Swasth Alliance, a collaboration of 92 health, tech, and healthtech organisations such as iSPIRT, Boston Consulting Group, 1MG, Pharmeasy, etc. has released a set of specifications for its draft health claims data exchange (HCX). Proposed under the Pradhan Mantri Digital Health Mission (PM-DHM), formerly known as the National Digital Health Mission, the HCX looks to facilitate the filing of requests and the disbursement of health insurance. The draft strategy for the PM-DHM, released in 2020, had mentioned the creation of a health claims platform as one of its objectives. In its consultation paper, the Swasth Alliance has not just laid down technical specifications of the proposed HCX but also presented guidelines for governance and grievance redressal processes. The full consultation paper can be viewed here. Stakeholders can submit their comments to the Alliance until October 8 at hcx@swasthapp.org. Summary of the HCX specifications Who can participate in the exchange? Provider: This would be the health service provider such as a hospital. Payor: This would be the insurance service provider. Agency: A third-party administrator acting on behalf of the payor. Regulator: Regulatory bodies like the Insurance Regulatory and Development Authority and the Insurance Information Bureau of India will be a part of the exchange. Research bodies: This would include research groups. E-commerce participants: E-commerce platforms facilitating insurance adoption like PolicyBazaar. Scheme sponsors: Scheme owners of specific programmes, e.g. NHA for Ayushman Bharat Other HCXs: Other health claims exchanges could be involved and interact with each other in the following circumstances: When a provider is onboarded in a gateway…
