Summary
Current status, enhancements from previous version and anticipated future roadmap
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Current status, enhancements from previous version and anticipated future roadmap
Last updated
Was this helpful?
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.
The following table provides a summary of the existing specification versions and links to the respective documentation.
Version - 0.6 (Baseline) | Release date - September 08, 2021 | Published documentation | Github | Consultation questions
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 .
Version - 0.7 (Draft) | Release date - January, 2022 | Published documentation | Github
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 | Github
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.
Version - 0.8 | Release date - April, 2023 | Published documentation | Github
The 0.8 version of HCX specifications has been developed based on inputs and feedback from the HCX community and in accordance with the planned roadmap. This version includes several key enhancements:
Notifications capability which allows for the sharing of important updates regarding the network, participants, and workflows with various entities.
Information Fetch API has been introduced to facilitate the sharing of information with authorized third parties.
API security enhancements have been made, which will allow for the generation of password-based API tokens.
Based on the business policy working group's recommendations, following enhancements have been made in the business policy specifications: improvements in onboarding and grievance redressal, as well as the inclusion of guidelines on SLAs, participant satisfaction, and operating charges.
Access control roles have been redefined to support the specification improvements and new use cases.
Please note that this version contains cumulative documentation and can be used by itself.