HCX Protocol
v0.9
v0.9
  • Summary*
  • Glossary*
  • Context
  • Introduction to HCX*
  • Technical Specifications
    • Open Protocol
      • Registries*
        • QR Code Specifications*
      • Claims Data Exchange (HCX) Protocol
        • Message Flows*
          • Primary Message Flow
          • Additional Message Flows
            • Redirect
            • Forward
            • Intra Cycle Communication*
              • Seeking Supporting Information
              • Seeking Beneficiary Consent
              • Seeking Account Information
            • Relay
            • Third party Information sharing
          • Notifications
            • Categories
            • List of key topics
        • Message Structure
        • API Specifications*
          • Registry APIs
          • Primary Flow APIs
          • Supporting APIs
          • Notification APIs
        • Error Handling
      • Data Security and Privacy
        • Transport Security
        • Message Security and Integrity
        • API Security*
      • Audit and Reporting
    • Digital Network Policies
  • Domain Specifications
    • Domain Data Models
      • Handling Attachments
      • Handling Processing Errors
    • Terminologies
    • Domain Specific Languages (DSLs)
    • FHIR Implementation Guide*
  • Business Policy Specifications
    • Access Control (Roles)*
    • Guidelines for Participant Onboarding*
      • Sandbox process
      • Production onboarding (Go live)*
      • Potential De-boarding scenarios
    • Guidelines for Grievance Redressal
      • Scope of disputes
      • Involved participants
      • Guideline process for dispute resolution
      • Guidelines for leveraging FTA
      • Next steps
    • Guidelines for SLAs and ecosystem satisfaction
    • Guidelines for Operating charges
    • Guidelines for Beneficiary Authentication by Providers/Payors
    • Guidelines for Event audits
    • Reference Templates
      • HCX - Terms of use
      • Payer-Provider addendum
      • Payer-Policyholder addendum
    • Next steps
  • Use cases*
    • OPD
      • Typical Workflows
        • Cashless
        • Reimbursement
      • Mapping to the HCX protocol
        • Cashless
        • Reimbursement
    • IPD
      • Typical Workflows
        • Cashless
        • Reimbursement
      • Mapping to the HCX protocol
        • Cashless
        • Reimbursement
    • Implementation Considerations
  • Contributing to the protocol
  • Future Focus Areas*
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  • Information Reporting
  • Fetching Information

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  1. Technical Specifications
  2. Open Protocol
  3. Claims Data Exchange (HCX) Protocol
  4. Message Flows*
  5. Additional Message Flows

Third party Information sharing

Enabling use cases for sharing information related to claims with other participants

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Last updated 1 year ago

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There are multiple use cases in the context of claims where certain information about the claims need to be shared to parties that are not directly involved in the claim processing cycle. Some such examples are:

  • Regulators like IIB need to collect information about the processed claims at the completion of a claims cycle. IIB uses this information to help the insurance industry with information and analytical support.

  • Sponsors like NHA/SHA/Corporate/Community need to know about completion and details of a claims cycle for all the patients sponsored by them.

  • An ISNP needs to know the status and details of a claim on behalf of its patient.

Such information can be made available to the interested parties in either of the following ways in HCX:

  1. Parties involved in the cycle can report the information to all the subscribed parties when a claim cycle is completed

  2. Parties who need information about a claim cycle can fetch the information from involved parties after the completion of a claim cycle (this is mostly be triggered when the interested party receives the relevant workflow notification)

Information Reporting

Information reporting can be enabled by leveraging the capability of the protocol. Since the information to be reported may contain PII information of the patients & other sensitive information, the “PII carrying workflow notification” category of notifications should be used for this purpose.

The steps and process for PII carrying workflow notifications are detailed in the .

Fetching Information

Though a mechanism to report information is available, there still may be some scenarios where the parties may need to fetch the required information on demand (e.g.: if the PII notification is not delivered due to technical problems). In such cases, there should be a way for the participants to fetch the required information by directly querying the involved party (a payor or a provider). As the current known use cases for information fetching are only around claim workflows and such information request can be fulfilled by sending the information in form of an ExplanationOfBenefit (EOB) resource, the protocol includes APIs to fetch claims related information using EOB resource. Details of these APIs are available here.

notifications
Notification specifications