githubEdit

Involved participants

List of participants involved and their role in the above mentioned types of disputes

Participant Type

Role

Comments

Payors (Insurers)

Complainant/Defendant

HCX role: payer

Health Care Providers

Complainant/Defendant

HCX role: provider

Health Insurance Intermediaries - (Licensed) - E.g., Brokers & Corporate Agents

Complainant/Defendant

HCX role: <TBD>

Health Insurance Facilitators (No licence) - E.g., distributors, marketers, facilitators (Includes Master policy holders and institutions that provide coverage through group policies including self insurance schemes)

Complainant/Defendant

HCX role: member.isnp

Third Party Administrators

Complainant/Defendant

HCX role: agency.tpa

Arbitrators (Online Dispute Resolution Entities )

Fast track arbitration process

Multiple entities to be empanelled by the HCX operator (HCX role: To be decided)

HCX Switch Operator

Complainant/Defendant

Data Provider

HCX role: HIE/HIO.HCX

In addition, participants like IRDAI (IGMS system - the existing dispute resolution platform) and insurance ombudsman and grievance redressal system in healthcare being co opted in subsequent phases.

circle-info

Each participant in the above list will be mapped with HCX participnt roels mentioned in the Access Control section.

Last updated

Was this helpful?