Mapping to the HCX protocol

Mapping the OPD workflows to HCX protocol

This section provides details of how typical cashless and reimbursement OPD workflows can be enabled through HCX protocol. It also highlights the key implementation considerations while implementing these workflows on HCX.

Through the implementation of these workflows via the HCX protocol, numerous challenges in cashless processing can be effectively tackled, significantly improving the overall quality and effectiveness of the services delivered and claims adjudicated. These improvements yield a range of benefits such as:

• Enhanced provider network

• Prompt coverage eligibility, pre-auth, & claim response

• Transparency on policy eligibility

• Enables payor systems to detect frauds

Following sub-sections will provide detailed HCX enabled OPD workflows.