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