NHCX Communication

Overview

Payers use NHCX to send communications to the hospital — queries about a claim, requests for additional information, and payment notices. You respond to these from the Communications table on the NHCX Kanban page using the communication form.

Communications

The NHCX Kanban page (/admin/hcx/nhcx/kanban) carries the case board on top and the communication log underneath it, headed Communications. The board shows only submitted cases, so a plan or coverage look-up that never became a claim gets no card. The log lists both directions — what the payer sent you and what you have replied — in a table with:

• Id — a link to the full FHIR record (errors show in red with a warning icon).
• Type — the communication API type, marked Received for a message the payer sent you (COMMUNICATION_REQUEST) or Sent for your reply (COMMUNICATION_ON_REQUEST).
• Date — when it was sent or received.
• Payer — the payer the message is with.
• Send Response — shown only for COMMUNICATION_REQUEST; opens the response form.

A payer's message on the case

A message the payer sends us is matched to its case — first by the exchange's correlation id, then by the claim number the payer quotes — and appears as a step on that case's workflow, marked Received. The status cell shows why the payer is writing (additionalinfo, tatquery, grievance, walletupdate, policychange, claimArbitration) and the message text, plus a document count when files came with it.

The step's next action is Answer payer's request, which opens the communication form for that message. Sending the answer stores it as the reply step on the same case, so the request and its answer sit together.

A message that matches no case is still recorded — it shows in the Communications log with no case attached rather than being discarded.

Files the payer sends

A payer's message can carry documents — a revised policy, a checklist, a photo of a signed form. Whatever the payer attaches is kept with the message and listed at the end of that message's case printout, under Documents received from the payer, one line per file showing the title, the type, and the resource it came from. Clicking a line downloads the file.

Nothing is copied into the patient's record; the files stay with the payer's message.

Sending a response

From a COMMUNICATION_REQUEST row, click Send Response to open the communication form.

1. Type — choose how the response payload is delivered: Pdf, Text, or Link.
2. Title — a title for the payload (hidden for Text).
3. Add Payload — add the response content. For PDF/Link this is the file or URL; for Text it is the message body. Instead of uploading a file, you can also use Choose from records to attach a document already stored against the patient (e.g. a prescription, consultation record, or discharge summary).
4. Submit.

The system builds a FHIR Communication resource addressed back to the payer and sends it through NHCX.

Common Issues

• Send Response not shown — only COMMUNICATION_REQUEST rows have a response action. A row marked Sent is your own reply, so there is nothing to answer.
• Error shown in red — click the Id link to view the full error details.

FAQ

Q: What is a COMMUNICATION_REQUEST? A: A message from the payer that requires a response from the hospital (e.g., a query on a claim or a request for a document).

Q: Can I send a document as my response? A: Yes. Choose Pdf and attach the file, or Link to provide a URL. You can also attach a document already stored in the patient's record using Choose from records.