# Future Focus Areas\*

Following are the list of potential enhancements envisioned/propsed by the community members for the future versions of the protocol. 

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Please note that this is a tentative list and that the community may revise and prioritise it according to the ecosystem needs.
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#### Tech and Domain related 

1. **Improvement in semantic interoperability (WIP) :** 
   * Defining higher confidence, harmonised valuesets based on ecosystem input
   * Valueset discoverability through terminology registry and services 
2. **Mechanism for challenging the claim adjudication process :** Enabling beneficiaries/providers to dispute claim adjudication outcomes via the Health Claims Exchange (HCX). This would help beneficiaries/providers with a standard mechanism to raise disputes, and streamline the challenge process, fostering increased transparency and trust in the system.
3. **Enabling multi payer - multi policy claim adjudication :** Enabling beneficiaries/ providers to submit claims to multiple payers for a given episode, e.g. when the treatment expenses exceed coverage limits, or certain procedures are not included in a specific policy.
4. **Analyse and expand for other OPD categories:** Exploring other categories within the OPD use case, understanding their unique challenges, and enhancing the workflow to address specific nuances. 
5. **Analysing/enhancing the protocol for non-insurance benefits (Corporate wellness, health CSR, community/cooperatives benefits) :** Broadening the scope of the Health Claims Exchange (HCX) to encompass a wider range of benefit scenarios, including corporate wellness, health CSR, and community/cooperative benefits. This strategic expansion aligns with our commitment to innovation and the realisation of the Universal Health Coverage (UHC) vision.
6. **Claim initiation using QR Code (WIP) :** Allowing consumers to initiate claims or pre-authorization flows conveniently by using QR codes, simplifying the initiation process. More details [here](https://github.com/hcx-project/hcx-specs/discussions/113) in the github comment.
7. **Enhancing CommunicationRequest cycle to allow structured Queries :** Enabling hospitals/payers to raise structured queries on the Healthcare Exchange (HCX) platform to payers/hospitals, improving communication and speeding up resolution for reimbursement-related inquiries.
8. **Enhancement in Insurance Plan object :** The existing profile only allows to declare limits at benefit level, but we cannot add conditions/rules of eligibility. Also, the values of limits could be expressions, not just values/constants always. 
9. **Multiple claims submission :** Analysis the feasibility of allowing multiple claims submissions against a single pre-authorization. 
10. **Detailed approach on handling attachments/supporting information :** Further elaboration on the multiple options to share the supporting information when not available in structured format.
11. **Further detailing of the domain objects (descriptions, examples, etc.) :** Enhancing IG to provide better description of the Profiles/Attributes/Valuesets and including more examples/use cases from the domain.
12. **Examples of typical use cases :** Adding real-life use cases of the medical episodes and insurance claims.
13. **Guidelines on Technical Operations of the HCX switch(es)/network**
14. **Notification Delivery status API**
15. **Notification - Failure and retry policies**
16. **Consumers wanting to unsubscribe notification from a HIU/ISNP** - Consumers may want to stop notifications from the HIUs (Like policy bazaar, etc.) or switch the HIU to get updates on their policies.

#### Policy related

1. **Workflow efficiency :** Assigning turnaround time (TAT) to each workflow step to streamline the OPD process and ensure timely handling of claims.
2. **Understanding Master policy holder (MPH) as stakeholder :**  Cater and engage with MPH as stakeholders to understand their specific use cases and analyse/prescribe/enhance the HCX  workflow and specifications to serve their needs.
3. **Fraud mitigation :** Assessing the potential risks of fraudulent activities in the OPD claims and implementing measures. This is already being discussed under the policy workstream. 
4. **Insurance agent persona :** Understanding the distinct needs of insurance agents as users of the platform and ensuring their requirements. 
5. **Digital contracting (WIP) :** Hospital Tariff document (Schedule of Charges, etc…) standardisation and contract between hospital and insurer.
6. **Further refinement of Provider onboarding process.** 
7. **Enhancements in model business policies in various operational areas.**