HCX Protocol


Key terms & their descriptions
Beneficiary Service Platform (BSP)
Digital platforms dedicated for assisting beneficiaries to track and file claims.
Coverage Eligibility
Process of checking if the beneficiary's policy is in force and cover the proposed goods, products and services.
Process of seeking payer's authorisation on the proposed set of goods, products and services and getting funds.
FHIR Profile
A JSON data structure that defines a domain model eligible to be carried as part of JWE payload in the HCX protocol APIs.
HCX Switch
Instance of the HCX gateway, implemented as per the HCX protocol, that facilitates the information exchange between its participants.
HCX Network
Instance(s) of HCX and their participating systems governed by a common network policy.
In-patient department (IPD)
Inpatient care, often referred to as the In-patient department (IPD), is a dedicated section within a healthcare facility specifically designed to deliver comprehensive medical care and treatment to patients or beneficiaries who require admission or an extended stay within the hospital.
Network participants
Any platform that has implemented the HCX protocol and becomes the part of a network as above.
A logical unit of information sent to relevant network participants. Notifications can be triggered by an event, activity or time trigger on the network.
Act of sending a notification.
Out patient department (OPD)
The Outpatient Department (OPD) is a distinct component of a healthcare facility, such as a hospital or clinic, dedicated to delivering medical services to patients who do not necessitate overnight hospitalisation.
Insurance provider, employer, organisation or an individual responsible for making payments, typically for services or goods delivered to the beneficiaries.
Pre -authorization/pre-auth
Process of seeking payer's authorisation on the proposed set of goods, products and services and reservation of needed funds.
Service provider is a facility, professional, or entity that offers required services and bills insurers or the beneficiaries for the services provided.
A tamper proof, audited collection of entries with their provenance.
Service delivery context in which beneficiary initially pays for the service expenses to the service provider, and then seeking reimbursement from their respective payer.
A JSON data structure that defines an entity as per OpenAPI 3.0 schema specifications.
Message structure with placeholder for context dependent data variable that helps in standardising the message parsing on the network.
Technical Service Provider (TSP)
Organisation that offers specialised technical support, services, or solutions to assist HCX network participants like providers, payers, etc.
Third party administrator (TPA)
Third-Party Administrator (TPA) in healthcare manages administrative tasks, such as claims processing and provider network management, on behalf of health insurance companies or self-funded employers.
Following sections provides details of the origins & need of the Health Data Exchange (HCX) effort.
Last modified 2mo ago