HCX Protocol
v0.8
v0.8
  • Summary
  • Context
  • Introduction to HCX
  • Approach
    • Design Principles
    • Key Specifications
    • Governance
  • Technical Specifications
    • Open Protocol
      • Registries
      • Claims Data Exchange (HCX) Protocol
        • Exchange Protocol
        • Message Structure
        • API Structure
        • Error Handling
      • Data Security and Privacy
        • Transport Security
        • Message Security and Integrity
        • API Security
      • Audit and Reporting
      • Notifications
        • Terminology
        • Categories
        • API specifications
        • List of key topics
        • Future considerations
      • Third party Information sharing
    • Digital Network Policies
  • Domain Specifications
    • Domain Data Models
      • Handling Attachments
      • Handling Processing Errors
    • Terminologies (Code sets or Metadata standards)
    • Domain Specific Languages (DSLs)
    • Implementation Guide
  • Business Policy Specifications
    • Access Control (Roles)
    • Guidelines for Participant Onboarding
    • Guidelines for Grievance Redressal
      • Scope of disputes
      • Involved participants
      • Guideline process for dispute resolution
      • Guidelines for leveraging FTA
      • Next steps
    • Guidelines for SLAs and ecosystem satisfaction
    • Guidelines for Operating charges
    • Guidelines for Beneficiary Authentication by Providers/Payors
    • Guidelines for Event audits
    • Reference Templates
      • HCX - Terms of use
      • Payer-Provider addendum
      • Payer-Policyholder addendum
    • Next steps
  • Contributing to the specifications
  • Future Roadmap
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  1. Business Policy Specifications
  2. Guidelines for Grievance Redressal

Scope of disputes

Envisioned list of disputes whose resolution can be facilitated by HCX

Initially envisioned List of Disputes HCX can assist with:

Dispute Category

Type of Dispute

Examples

Delays

TATs related disputes

  • Delay in submission of supporting documents e.g., hospital bills, discharge summary to the insurer

  • Delay in processing claims

  • Delay in communicating pre-authorization approval/rejections to the customers

  • Delays from HCX Switch Operator

Data Transmission Related

Disputes related to transmission failures (packet drop)Disputes related to transmission data mismatch between origination and receipt

  • Delay in data transmission

  • Data mismatch

  • Data transmission failure

Data Privacy

Disputes related to data privacy violation by an entity in the HCX ecosystem

  • Data sharing without consent

  • Data storage which is not in compliance with agreed standards

Policy Related (E.g., Onboarding )

Disputes related to the non compliance of HCX with respect to HCX policies

Examples

  • Onboarding entities not in accordance to HCX policies

  • HCX not agreeing to share data for dispute resolution

  • HCX not in compliance with contractual agreements like fast track arbitration

Enforcement of Data Standards

Disputes related to members of the HCX ecosystem not adhering data transmission standards

  • Non compliance with agreed data formats

The list of disputes is not exhaustive and the categories may grow with subsequent iterations

PreviousGuidelines for Grievance RedressalNextInvolved participants

Last updated 2 years ago

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