Ayushman Yojana Launches New Portal: The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is India’s largest publicly funded health insurance scheme, aimed at providing free healthcare to the economically vulnerable sections of society. Since its inception in 2018, the scheme has enabled millions of Indians to access quality medical care without the burden of financial stress. Despite its widespread benefits, one of the persistent issues has been claim settlement delays, which have not only caused inconvenience for hospitals but also disrupted patient care and treatment continuity.
In a groundbreaking move to modernize and simplify the claims process, the Government of India, through the National Health Authority (NHA), has launched the National Health Claims Exchange (NHCX). This unified, digital-first platform promises faster claim approvals, real-time transparency, and improved collaboration between hospitals, insurance companies, and government health schemes.
Ayushman Yojana Launches New Portal
| Feature | Details |
|---|---|
| Scheme Name | Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) |
| New Initiative | Launch of National Health Claims Exchange (NHCX) |
| Launch Year | 2025 |
| Key Objective | Eliminate claim delays; standardize and automate reimbursement processes |
| Developed By | National Health Authority (NHA) |
| Technology Partners | IRDAI, NIC, Insurance providers, Private tech firms |
| Target Users | Insurance companies, hospitals, TPAs, govt. health schemes, and patients |
| Expected Impact | Faster reimbursements, improved hospital confidence, cost savings |
| Pilot Phase | June 2024 |
| Full Rollout | Nationwide by March 2025 |
| Official Website | https://pmjay.gov.in |
The launch of NHCX under Ayushman Bharat is a milestone in India’s digital health journey. It addresses the root cause of inefficiency in the health insurance sector—fragmentation—by offering a unified, smart, and scalable solution. Whether you’re a hospital administrator, patient, or insurer, the NHCX ensures a smoother experience, quicker outcomes, and more trust in public health infrastructure.
As India moves towards Digital Health 2.0, platforms like NHCX will serve as the backbone of accessible, equitable, and accountable healthcare. If implemented with the right checks and training, this system can eliminate red tape and bring peace of mind to every Indian citizen.
NHCX is not just an upgrade—it’s a revolution in how India processes and pays for care.
What Is the National Health Claims Exchange (NHCX)?
The National Health Claims Exchange (NHCX) is a unified digital infrastructure designed to standardize, streamline, and digitize the entire healthcare claims lifecycle. Developed by the National Health Authority (NHA) in collaboration with the Insurance Regulatory and Development Authority of India (IRDAI), this platform acts as a central hub for all health insurance-related transactions.
NHCX connects hospitals, insurance companies, third-party administrators (TPAs), and government agencies through a common digital pipeline, using secure APIs and interoperable formats to ensure quick, secure, and error-free processing.
Core Objectives of NHCX:
- Reduce claim settlement times to under 3 hours
- Create a pan-India ecosystem for health claims
- Enable cashless discharges with minimal paperwork
- Establish transparency and accountability at every level
- Minimize fraud and duplication through AI-powered validations
NHCX is expected to handle over 10 crore claims annually by 2026.
Why Was There a Need for a New Claims Platform?
The success of Ayushman Bharat was being overshadowed by operational inefficiencies, especially at the claims processing stage. Hospitals voiced concerns over long-standing dues, often running into crores, while patients faced discharge delays due to claim authorization bottlenecks.
Systemic Challenges Before NHCX:
- Over ₹1.2 lakh crore in pending claims as of early 2025 (Himbumail)
- Over 600 hospitals threatened to withdraw services in states like Haryana due to unpaid dues (TOI Report)
- Multiple claim platforms per state, causing redundancy and delays
- No unified grievance redressal mechanism
- Limited use of digital tools like auto-verification or tracking dashboards
These gaps not only hampered efficiency but also undermined trust in the system. NHCX was conceptualized to replace this patchwork model with a single-window claim exchange that would serve both public and private stakeholders.
How Does the New Portal Work?
NHCX introduces an automated, stepwise workflow that reduces human intervention and leverages digital intelligence. Its interoperability means that hospitals and insurers can connect their existing software through APIs without overhauling their internal IT systems.
End-to-End Workflow:
- Patient admitted to an empaneled hospital
- Hospital uploads treatment details to NHCX in real-time
- Claim is auto-verified using predefined rules and AI algorithms
- Insurer receives claim instantly and approves based on policy norms
- Hospital receives payment digitally within hours
- Patient discharged with no payment required at hospital end
Key Features:
- Digital consent architecture
- Real-time dashboards for claim status
- Smart notifications for pending tasks
- Fraud detection using pattern recognition
- Role-based access control for privacy
By 2026, 90% of government scheme claims are expected to be routed via NHCX.
Benefits of NHCX for Key Stakeholders
Hospitals:
- Increased working capital due to timely reimbursements
- Transparent claims tracking reduces disputes
- Faster discharge times improve patient turnover
- Seamless integration with existing HMS software
Patients:
- Reduced wait time during discharge
- No out-of-pocket expense for treatment under scheme
- Higher hospital participation increases treatment access
Insurers & TPAs:
- One interface to manage all claim types
- Reduced paperwork leads to better operational efficiency
- Standardized formats simplify approvals
- Smart fraud analytics and duplicate claim detection
“The NHCX is the UPI moment for health insurance.” – Industry Expert
NHCX vs. Traditional Claims System – A Comparative Overview
| Criteria | Old System | NHCX Platform |
|---|---|---|
| Data Format | State-wise, inconsistent formats | Single interoperable standard |
| Claim Approval Time | 5–30 days | < 3 hours (expected) |
| Cost per Transaction | High due to manual review | Significantly lower via automation |
| Hospital Participation | Declining due to payment delays | Expected to increase with efficiency |
| Transparency | Poor tracking, no visibility | Real-time monitoring through dashboards |
| Integration | Fragmented systems | One digital window |
PM Dhan Dhanya Krishi Yojana 2025 for Farmers, Check Benefits and Eligibility
₹2 Lakh Coverage at Just ₹20: All About PM Suraksha Bima Yojana!
Financial Aid of ₹75,000 for Girls’ Education Through Sarkari Yojana: How to Get it?
How to Get Started – A Guide for Hospitals
- Registration:
- Visit https://pmjay.gov.in
- Navigate to “Hospital Empanelment” under NHCX section
- Upload KYC documents, PAN, and GST registration
- Await digital onboarding confirmation
- Tech Integration:
- Connect Hospital Management System (HMS) to NHCX APIs
- Use sandbox environment for testing before live integration
- Claim Submission:
- Ensure e-records of admission, treatment plan, discharge summary
- Attach diagnostics, consent, and e-invoices in NHCX format
- Monitor & Resolve:
- Track real-time claim status on dashboard
- Respond to queries from insurers within SLA timelines
- Download monthly settlement summaries
FAQs On Ayushman Yojana Launches New Portal
Q1. Is NHCX limited to Ayushman Bharat only?
A: No. While it supports PMJAY, NHCX is built to handle claims from private health insurance too.
Q2. Is it compulsory for hospitals to register?
A: Yes, to submit and receive claims under NHCX, hospitals must be registered and digitally integrated.
Q3. Can patients track their own claims?
A: Yes, patients can use their Aadhaar-linked mobile number to track claim status via SMS or app notifications.
Q4. What happens to claims raised before 2025?
A: They will be processed under the legacy system. All new claims post-rollout must be submitted via NHCX.
Q5. Is training provided to hospital staff?
A: Yes, the NHA is conducting regular webinars, workshops, and offers online documentation and support.
