Envisioned list of disputes whose resolution can be facilitated by HCX
Initially envisioned List of Disputes HCX can assist with:
The list of disputes is not exhaustive and the categories may grow with subsequent iterations
Last updated
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
