Access Control (Roles)
Participating systems in the Claims information exchange ecosystem may possess one or more of the following roles. These roles are based on the base set of organisation roles defined in hl7 specifications here. Namespaced coding is used to further qualify the role in the context of the claims exchange process.
provider: Health Service Provider
payer: Insurance service provider
agency.tpa: Third party administrator acting on behalf of the payer. In the current version, this role is expected to behave like a payer from the data exchange perspective.
agency.regulator: IRDAI and IIB like regulatory bodies.
research: Research groups, etc.
member.isnp: eCommerce platforms facilitating insurance adoption
agency.sponsor: Scheme owners of specific programs, e.g. NHA for Ayushman Bharat
HIE/HIO.HCX: Other HCXs
The following table further describes these roles for their corresponding access rights and scenarios for version 1 of the claims exchange process:
Questions for Consultation
Question 1
The primary stakeholders/roles in the HCX ecosystem are mentioned in the section Access Control. Are there any other primary or secondary stakeholders that should be considered as HCX participants? If yes, please outline their role in the HCX ecosystem.
Question 2
This section also mentioned allowed actions for the current set of stakeholders, please review these actions and suggest any changes needed for those actors.
Instructions to send responses to the consultation questions are available here.
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