NHCX for Hospitals: National Health Claims Exchange Explained

What is NHCX?

The National Health Claims Exchange (NHCX) is part of the Ayushman Bharat Digital Mission, built by the National Health Authority (NHA). It works as a switch between the parties to a health insurance claim: hospitals and other providers on one side, and insurers, TPAs and schemes on the other. Each party connects once to the exchange, and the exchange routes messages to the right recipient.

The aim is to replace a patchwork of insurer portals, TPA e-mails, scanned documents and phone follow-ups with structured messages that every party can read in the same way. For a hospital billing desk, that means fewer portals to log in to and claim data that a computer can check, not only a pile of PDFs.

The insurance regulator supports the move. The IRDAI Master Circular on Health Insurance Business of 29 May 2024 asks insurers to onboard hospitals on NHCX, alongside its timelines for cashless decisions. Terms such as TPA, pre-authorisation and FHIR are explained in our glossary.

Who does what on NHCX

How a claim flows through NHCX

A cashless claim on NHCX follows the same steps that billing teams already know. What changes is that each step is a structured message rather than a form on a payer's website.

1. Coverage eligibility check: at admission, the hospital's software asks whether the patient's policy is active and what it covers.
2. Pre-authorisation: the hospital sends the estimated cost, diagnosis and planned treatment, with supporting documents. The insurer or TPA replies with an approval, a query or a rejection.
3. Enhancement: if the stay or treatment changes, the hospital sends a request to raise the approved amount.
4. Discharge and claim: at discharge, the hospital sends the final claim with the itemised bill, discharge summary and reports.
5. Queries and responses: questions and replies travel through the exchange, so the history stays with the claim.
6. Settlement: the payer returns the settled amount and any deductions, which the hospital records against the receivable.

FHIR claim bundles in plain terms

NHCX messages use FHIR, an international standard for exchanging health data, with profiles for India published by NRCeS in the FHIR Implementation Guide for ABDM. A "bundle" is a single package that holds all the pieces a request needs: the patient, the policy, the hospital, the diagnosis, the line items and the attached documents.

The NRCeS ClaimBundle profile describes a bundle of type collection in which all the supporting information needed to process a claim can be shared, and its examples cover pre-authorisation, enhancement, predetermination and settlement. You do not need to read the profiles yourself, but your software vendor does, and the quality of your data decides how clean those bundles are.

What hospitals need to use NHCX

• A facility identity in ABDM: registration in the Health Facility Registry is the usual starting point for ABDM services; confirm the current onboarding requirements with the NHA.
• Onboarding as a participant: the hospital, or its software on its behalf, registers on the exchange and completes testing before going live. Check the current process on the NHCX portal.
• Software that builds and reads the bundles: your HMS must turn the admission, bill and documents into valid FHIR bundles and show replies to the billing team.
• Clean masters: payer lists, tariffs, packages and diagnosis and procedure entries that match what insurers expect.
• Documents in digital form: discharge summaries, reports and bills generated or stored in the software rather than only on paper.
• Payers who are live: each insurer or TPA you work with must also be on the exchange for that claim to move through it.

Is NHCX mandatory for hospitals?

As of October 2026, IRDAI's instructions on NHCX are addressed to insurers, and we are not aware of a general legal requirement that every hospital must file claims through NHCX. Insurers are being asked to bring hospitals onto the exchange, so expect your insurers and TPAs to raise it. Check the current position with the insurers and schemes you work with, since requirements can change.

Benefits and practical limits

The timelines in the IRDAI circular, a one-hour decision on cashless requests and three hours for final discharge authorisation, put pressure on the hospital as well as the insurer. If the discharge summary and final bill are not ready, no exchange can make the claim faster. Our discharge summary format guide helps with that part.

Questions to ask any software vendor about NHCX

Many vendors mention NHCX. Ask for specifics and see them working before you rely on any claim, including ours.

• Is your software live on NHCX in production today, or only tested in a sandbox? Which hospitals use it?
• Which flows are supported: coverage eligibility, pre-authorisation, enhancement, claim, query replies, settlement?
• Which insurers and TPAs have you exchanged real claims with?
• Which version of the NRCeS NHCX profiles do you follow, and how do you handle updates?
• How are documents such as the discharge summary attached to the bundle?
• What happens to a claim if the exchange or the payer is unavailable?
• Does the NHCX connection cost extra, per claim or per year?

Getting ready now, whatever your software

1. Register your facility in the HFR if you have not already.
2. Clean your payer, tariff and package masters.
3. Make the discharge summary and itemised bill come from the same record.
4. Keep claim documents digital and linked to the admission.
5. Track every claim as a receivable by payer and age, so you can measure the change once you move to the exchange.

For the wider claim workflow, including PM-JAY and TPA bill splits, read our guide to PM-JAY, TPA and insurance claims and the OPD, IPD and TPA billing guide.

How Sehat Nxt helps

Sehat Nxt hospital billing keeps a payer master, splits a bill between the patient and a payer such as an insurer or government scheme, and tracks TPA claims from dispatch and acknowledgement through to settlement, with deductions recorded. The discharge summary and charges from IPD management sit with the same admission. Sehat Nxt is ABDM M1, M2 & M3 Ready. For NHCX, ask our team what is available for your hospital and see it in a demo, as you would with any vendor.

Plans start from ₹999 per month. Book a free demo and bring one recent TPA claim to walk through.