Next steps

Envisioned next steps to a robust dispute resolution process for the ecosystem

An effective and comprehensive digital dispute resolution system is vital to the success of HCX. While this document refers to the first phase - commercial health insurance for in-patient procedures, the end goal is to resolve a majority of insurance claims related disputes before it reaches the legal system. Initiatives like integrating with various existing and emerging grievance resolution mechanisms in the insurance and healthcare ecosystem is important for HCX to achieve this vision.

Keeping this in mind, the policy guidelines workign groups would keep working to evolve the guidelines based on ecosystem needs. It would mainly cover following aspects:

  1. Further simplification and posiible automation of the process

  2. Broadening of scope for other use cases - reimbursement, OPD, etc.

  3. Integration of HCX scope into the larger ecosystem process like insurance ombudsman and other upcoming grievance redressal system in healthcare

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