Current status, enhancements from previous version and anticipated future roadmap

Inspired by the recommendations of the Joint Working Group of NHA and IRDAI (2019), Health Claims Data Exchange (HCX) is an ambitious open source project that aims to define interoperable protocol specifications to enable a multi-party exchange of health claims information.

The HCXs can be thought of as routing switches or email gateways that facilitate communication with the desired level of consistency, security, privacy, and durability. However, unlike the internet or email, this protocol is defined for a specialized use case of exchanging health claims-related information between relevant actors - payors, providers, beneficiaries, regulators, observers, etc.

Current Status

The following table provides a summary of the existing specification versions and links to the respective documentation.

Version detailsDescription

Version - 0.6 (Baseline) | Release date - September 08, 2021 | Published documentation link | Github link | Consultation questions link

Base version of specifications. It was built by 60+ volunteers from across the healthcare ecosystem (including Insurers, Hospitals, TPAs, Insurance Technology players and Think tanks) as a part of a transparent, collaborative and open effort during July 2020-September 2021 and launched for public consultation on September 08, 2021. You can find the launch details and list of volunteers here.

Version - 0.7 | Release date - November 17, 2022 | Published documentation link | Github link | Consultation questions link

Based on feedback from various ecosystem players on the baseline version and rigorous feasibility analysis with the NHA team on the adoption of the specifications in public scheme use cases, this version includes the following key enhancements over the baseline version:

  • Multi-party processing support through REDIRECT and FORWARD constructs

  • Initial support for digital encoding of policies using InsurancePlan FHIR profile

  • New APIs to support pre-determination cycle

  • Introduction of communication APIs to support additional information exchange during various claim cycles - pre-determination, pre-auth, or claims.

  • Introduction of status API to support fetching of the status of a submitted request

  • Search API definition deferred to future version to allow further deliberation

  • Simplification of Protocol Headers - identifiers and status

  • Standardisation of protocol errors

  • Restructuring, examples, and language modifications to enhance readability

Version - 0.7.1 | Release date - February, 2023 | Published documentation link | Github link

After consulting with NRCes, the FHIR community, and the HCX community, this version of specification incorporates a significant simplification by changing the bundle type from "document" to "collection." This new structure effectively reduces the overhead associated with the "document" bundle type and supports cycle-specific constraints on the bundles, making the integration process much more straightforward for integrators.

Some of the significant advantages of using the "collection" bundle type include simplifying programming for bundle parsing and verification, eliminating extraneous details such as the signature, and reducing the payload size.

In summary, this new bundle type significantly streamlines the integration process and reduces unnecessary complexities, ultimately improving the overall experience for all parties involved.

Please note that this version contains cumulative documentation and can be used by itself.

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