National Health Claims Exchange (HCX)-Sandbox

National Health Authority (NHA) invites participation on the ‘National Health Claims Exchange (HCX)-Sandbox’ under Ayushman Bharat Digital Mission (ABDM)

The National Health Authority (NHA) invites contributors and developers from the open community, especially those working in the Health Insurance and Healthcare Provider space to test, contribute and become a participant in the Health Claims Exchange Ecosystem by onboarding on the HCX – Sandbox Environment. NHA announced HCX as a new initiative under the Ayushman Bharat Digital Mission (ABDM) on 23rd September 2022 and subsequently worked with various groups to come up with Health Insurance Exchange specifications.

The current health insurance claims settlement process in the country is mostly manual, non-digital and laborious in nature posing challenges at every stage. The current process of exchanging claims lacks standardization across the ecosystem with most data exchange occurring through PDF/manual methods and processes vary significantly among Insurers, TPAs, and Providers leading to high cost of processing each claim.

To tackle these key challenges and streamline the process of claim settlement, NHA has developed a national Health Claims Exchange (HCX) to enable interoperability of health claims. The HCX serves as a protocol for exchanging claims-related information among various actors, including payers, providers, beneficiaries, regulators, and observers. It is designed to be interoperable, machine-readable, auditable, and verifiable which helps ensure that the information being exchanged is accurate and trustworthy.

HCX will act as a gateway (with validation and routing capabilities) for the ecosystem wherein the Insurers/ TPAs shall send responses for each FHIR based e-claim submitted by providers via the HCX through standard protocols (APIs).

With a vision to standardize the claims process, HCX will lead to reduction in operational overheads and increase the trust among payers and providers through a transparent and rule-based mechanism, it will reduce claims processing cost, expedite pre-authorization or patient discharge approvals, improve patient experience, better visibility for tracking the claims and have better quality data for industry and regulators.

To ensure the success and adoption of the claims network, it is essential to onboard participants on the HCX ecosystem, therefore it is requested that all interested solution providers, payers, and provider to actively participate and utilize the services of the HCX – Sandbox, the key goal of the sandbox is to help the ecosystem test its specific components against the communication standards and get certified to become a part of the system.

The interested participants can submit an online application to express their interest to access the HCX sandbox on https://sbxhcx.abdm.gov.in/. On successful verification, the approved participants are added to the HCX sandbox and provisioned with the necessary credentials to access the sandbox environment. The link also provides all necessary documentation for participation along with the HCX specifications and FHIR profiles.

The FHIR Implementation Guide (IG) for ABDM has been updated to support HCX specifications. The preview of the IG is hosted at – https://www.nrces.in/preview/ndhm/fhir/r4/hcx-profile.html.

Source: https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1917688

Announcement – Digital Health Incentive Scheme (DHIS) by NHA

Digital Health Incentive Scheme (DHIS) by NHA

The National Health Authority (NHA) has announced a Digital Health Incentive Scheme (DHIS) for the stakeholders of the digital health ecosystem. The scheme aims to give a further boost to digital health transactions in the country under the Ayushman Bharat Digital Mission (ABDM). The incentives under this scheme would be provided to hospitals and diagnostic labs and also to the providers of digital health solutions such as Hospital/ Health Management Information System (HMIS) and Laboratory Management Information System (LMIS).

Under the DHIS, the eligible health facilities and digital solutions companies shall be able to earn financial incentives of up to Rs. 4 crores based on the number of digital health records they create and link to ABHA (Ayushman Bharat Health Account). This incentive can be availed by the health facilities (hospitals and diagnostic labs) registered with ABDM’s Health Facility Registry (HFR) and fulfilling the eligibility criterion specified under the scheme.

Important points under ABDM’s Digital Health Incentive Scheme are:

  1. Incentives would be provided to the following entities:
    1. Health Facilities having 10 or more beds
    2. Laboratory/radiology diagnostics centres
    3. Digital Solution Companies (entities providing ABDM enabled digital solutions)
  2. The incentives shall be provided on the basis of the number of ABHA-linked transactions i.e. the digital health records created and linked to ABHA.
Healthcare FacilityBase Level Criteria   Incentives
Hospitals50 Transactions per bed per monthRs. 20 per additional transaction above the base level
Diagnostic facilities /Labs500 Transactions per monthRs. 15 per additional transaction above the base level
  1. Digital Solution Companies (DSCs) will be given an incentive of 25% of the incentive amount received by the eligible health facilities using their digital solutions.
  2. For the ABHA linked transactions done by facilities not eligible for direct incentives (Clinics/ Small Hospitals/ Health Lockers/ Teleconsultation Platforms etc.), an incentive would be provided to Digital Solution Companies.
Cost Incentives for Digital solution (HMIS and LMIS) Companies
For every Transaction by hospitals/labs using their software and receiving incentives under this policy25% of the corresponding incentive amount received by the eligible facilities
For other Transactions (including by health lockers, Teleconsultation platforms, small clinics etc.), provided the transactions are more than 200 per monthRs. 5 per Transaction

NHA is organising public webinars starting from Dec 23, 2022 to provide detailed overview of the scheme. The schedule and link for the webinars will be available on the website https://abdm.gov.in/dhis

Source: https://abdm.gov.in/DHIS

NHA issues hardware guidelines for effective implementation of Ayushman Bharat Digital Mission

NHA issues hardware guidelines for healthcare institutions at State/ UT level to facilitate effective implementation of Ayushman Bharat Digital Mission

The National Health Authority (NHA) issued hardware guidelines across States and Union Territories for healthcare institutions like hospitals, clinics and health and wellness centres to promote digitization in hospitals.

The guidelines provide a basic framework to States/UTs for planning, assessment and procurement of the IT hardware (including IT specifications of various hardware equipment) to operate applications compliant with Ayushman Bharat Digital Mission (ABDM).

The guidelines on the IT hardware specifications to support this ecosystem is available at https://abdm.gov.in:8081/uploads/Hardware_Guidelines_ABDM_e162cf7a7b.pdf. The document will help the States/ UTs in assessing the hardware requirements while planning and procurement of IT assets for healthcare institutions of all scales.

The guidelines published by NHA is suggestive and recommendatory in nature. States/UTs and the health facilities have the flexibility to modify these guidelines based on local requirements and circumstances.

Source: Posted On: 22 AUG 2022 4:17PM by PIB Delhi
source link: https://pib.gov.in/PressReleseDetailm.aspx?PRID=1853603

NHA Joins hands with QCI to Accredit ABDM Compliant Healthcare Solutions

National Health Authority (NHA) joins hands with Quality Council of India (QCI) to accredit ABDM compliant healthcare solutions like HMIS/LMIS

The National Health Authority (NHA) has onboarded the Quality Council of India (QCI) for six months to accredit and rate HMIS (Health Management Information System)/ LMIS (Laboratory Information Management System) solutions that have integrated with Ayushman Bharat Digital Mission (ABDM).

NABH will undertake the responsibility of accrediting and rating the ABDM compliant solutions on various parameters, including ease of usage, user interface, pricing, number of modules/features and value for money/pricing so that prospective purchasers may get credible information.

The purpose of this initiative is to encourage innovations by streamlining delivery of health tech services in a significant way. To develop a framework to ensure that ABDM compliant digital healthcare solutions are accredited and rated and to adequate information is available to consumers for choosing one solution over another.

Accredited health tech solutions will help healthcare organizations manage their patient journeys and business more methodically in accordance with ABDM standards. And ultimately, this initiative will help the citizens of India get better and more timely healthcare and help India become one of the leaders in digitization of healthcare in the world”

This accreditation exercise will be conducted in a phased manner. Phase I shall focus on accreditation and rating of HMIS solutions successfully integrated with ABDM. Subsequent phases shall include other subjective parameters and other categories of healthcare solutions like LMIS, Health Lockers, Health Tech,PHR (Personal Health Records) apps etc.

Source : Posted On: 04 AUG 2022 6:12PM by PIB Delhi

AB PM-JAY Announcement

Hospital Empanelment Module (HEM)-Diagnostic Center Registration under AB PM-JAY – Announcement from NHA

Guidelines on Process of Registration for Diagnostic Centres
AB PM-JAY has been empanelling hospitals till now. Whatever services were required for providing the care to patients had to be provided by the hospital – either in-house or through outsourcing. With the advent of Corona pandemic and foreseeing the requirement an important step in the diagnosis of the ailment, a need was felt to expand the testing capacity for the benefit of AB PMJAY beneficiaries, hence the packages for diagnostics testing are been notified by NHA. Also. after the request of industry NHA has decided to start registration of the diagnostic centers (Laboratory & Radiology). NHA has developed the module to register the diagnostic centers.

The following are the requirements for registration of the diagnostic (Laboratory & Radiology) center

Licenses/ Certificates:
i. Diagnostic Centre Registration Certificate as per state/UTs laws
ii. NABH certificate
iii. NABL certificate (as applicable)
iv. AERB Registration & License
v. PCPNDT Certificate (If applicable)
vi. CGHS/ECHS empanelment document
vii. Government Hospital Diagnostic Centre
a) Declaration on letter of appropriate authority/head of institution (Medical Superintendent or dean)

Process for Application:

  1. The centers can apply through HEM platform for registration with AB PM-JAY.
  2. Every center willing to get registered will need to visit the web portal, https://hospitals.pmjay.gov.in create an account for themselves.
  3. Once the login ID is created, center shall apply for registration through an online application form on the web portal link available on https://hospitals.pmjay.gov.in
  4. All the required information and documents will need to be uploaded and submitted by diagnostic center through the web portal.
  5. After registering on the web-portal, the center user will be able to check the status of their application.

Download the full document for more information from the link below :

Hospital Empanelment Module(HEM)-Diagnostic Center Registration under AB PM-JAY .
NHA has released a Self Help Guide for Hospitals to complete the empanelment processes.

Guide comprises of the following information :

❖ Account Creation
❖ Diagnostic Center Basic Information
❖ Financial Details
❖ Specialties Offered
❖ Investigations
❖ List of Hospitals
❖ Licenses and Certificate
❖ Check Eligibility and Submit

Before submitting the registration request, the authorized diagnostic center representative has to create an account through which detailed information will be submitted. The steps for creating the account are given in the Self Help Guide created by NHA which is shared below for reference.


Download the Self Help Guide for the Empanelment Process.

Source : https://pmjay.gov.in/resources/documents