About

• The Ayushman Bharat Digital Mission (ABDM) was launched by the Government in 2020 for promoting digitization of healthcare and creating an open interoperable digital health ecosystem for the country. 
• It aims to do so by prescribing common health data standards, developing core modules such as registry of health facilities, healthcare professionals etc required for interoperability; so that various digital health systems can interact with each other by enabling seamless sharing of data across various healthcare providers who may be using different digital health systems.
• ABDM will create certain core building blocks or modules such as registries of individuals/citizens/patients (Health ID registry), registry of healthcare professionals (Healthcare Professionals Registry) and registry of healthcare facilities including hospitals, laboratories, pharmacies, etc (Health Facility Registry). In these registries, each of these entities is provided with a unique identifier across the ecosystem. 
• Any individual can enroll in ABDM to generate a Health ID (https://healthid.ndhm.gov.in/). Healthcare professionals recognized by Indian authorities can register on the Healthcare Professionals Registry (HPR) (https://hpr.ndhm.gov.in/en). Health facilities can register themselves on the Health Facility Registry (HFR) (https://facility.ndhm.gov.in/).
• Participation in ABDM is voluntary including for citizens. Participation of a healthcare facility or an institution is also voluntary and shall be taken by the respective management (government or private management). 

Significance

• The implementation of ABDM is expected to significantly improve the efficiency, effectiveness, and transparency of health service delivery overall. Patients will be able to securely store and access their medical records and share them with health care providers to ensure appropriate treatment and follow-up. 
• They will also have access to more accurate information on health facilities and service providers. Further, they will have the option to access health services remotely through tele-consultation and e-pharmacy. 
• ABDM will empower individuals with accurate information to enable informed decision making and increase accountability of healthcare providers.
• Similarly, health care professionals across disciplines will have better access to a patient’s medical history (with the necessary informed consent) for prescribing more appropriate and effective health interventions. 

Implementing agency

• • The National Health Authority (NHA), the apex agency responsible for the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), has been given the mandate by the government to design, build, roll-out and implement the ABDM in the country. 

• NHA is an attached office of the Ministry of Health and Family Welfare with full functional autonomy.

Why in News?

• The National Health Authority (NHA) invites contributors and developers from the open community, especially those working in the Health Insurance and Healthcare Provider space to test, contribute and become a participant in the Health Claims Exchange Ecosystem by onboarding on the HCX – Sandbox Environment. 
• NHA announced HCX as a new initiative under the Ayushman Bharat Digital Mission (ABDM) on 23rd September 2022 and subsequently worked with various groups to come up with Health Insurance Exchange specifications.
• The current health insurance claims settlement process in the country is mostly manual, non-digital and laborious in nature posing challenges at every stage. The current process of exchanging claims lacks standardization across the ecosystem with most data exchange occurring through PDF/manual methods and processes vary significantly among Insurers, TPAs, and Providers leading to high cost of processing each claim.
• To tackle these key challenges and streamline the process of claim settlement, NHA has developed a national Health Claims Exchange (HCX) to enable interoperability of health claims. The HCX serves as a protocol for exchanging claims-related information among various actors, including payers, providers, beneficiaries, regulators, and observers. It is designed to be interoperable, machine-readable, auditable, and verifiable which helps ensure that the information being exchanged is accurate and trustworthy. HCX will act as a gateway (with validation and routing capabilities) for the ecosystem wherein the Insurers/ TPAs shall send responses for each FHIR based e-claim submitted by providers via the HCX through standard protocols (APIs).

https://pib.gov.in/PressReleasePage.aspx?PRID=1917688