NHCX Overview

Overview

NHCX (National Health Claims Exchange) is the standard platform for exchanging claims and pre-authorization between healthcare providers (hospitals) and payers (insurers / government schemes such as PMJAY). Instead of each hospital talking to each insurer directly, a hospital sends standard FHIR-based bundles to NHCX, which routes them to the correct payer.

Within the system, the NHCX module lets you:

• Check a patient's coverage and eligibility against a payer.
• Submit pre-authorization and claim requests.
• Cancel a pre-authorization.
• Reprocess an erroneous or partially-paid claim.
• Respond to payer communications (queries, payment notices).
• Capture biometric verification (fingerprint / iris / face auth) required for admission and discharge.

Claim lifecycle

A typical NHCX workflow moves through these stages:

1. Eligibility check — confirm the patient's policy, coverage, and benefits.
2. Pre-authorization — get approval for the planned treatment.
3. Admission / treatment — biometric capture at admission, then at discharge.
4. Claim — submit the final claim for reimbursement.
5. Payment / communication — track payment notices and respond to queries.

Prerequisites

Before any NHCX workflow can run, the following must be in place:

• Plan entitlement — NHCX is available on the Hospital, Lab, Enterprise and LargeEnterprise plans, with a valid (unexpired) HIMS subscription. Enterprise and LargeEnterprise include it; Hospital and Lab must buy the separate annual NHCX subscription before they can process transactions. Clinic and Free plans cannot use NHCX. See Pricing & Plans.
• Provider onboarding — the hospital must be registered as an NHCX participant with an active participant code (see NHCX Participant ID Generation).
• HFR ID — a valid ABDM Health Facility Registry ID for the organization.
• Payer discovery — the payers you work with must be discoverable/registered on the exchange.
• Patient ABHA — patients need an ABHA number (and, for biometric flows, Aadhaar-linked mobile).

Registering vs. processing. These are separate rights. Registering a participant code needs a valid HIMS subscription but not an active NHCX subscription. Processing pre-authorizations and claims needs an active NHCX subscription (or a plan that bundles it).

Key concepts

Where everything lives

FAQ

Q: Is NHCX the same as ABDM? A: No. ABDM is the broader Ayushman Bharat Digital Mission (health IDs, health records, linking). NHCX is the claims exchange that runs on top of it and uses ABHA numbers for patient identity.

Q: Who uses the NHCX module? A: Hospital admins and front-desk/billing staff who process claims and pre-authorization for patients with covered policies.

Q: What schemes does it support? A: It is payer-agnostic. PMJAY is a common scheme, but any payer registered on NHCX can be used.

Q: Which plans can use NHCX? A: Hospital, Lab, Enterprise and LargeEnterprise. Enterprise and LargeEnterprise include NHCX at no extra charge, valid until the HIMS subscription ends. Hospital and Lab must buy a separate annual NHCX subscription from the pricing page — it is yearly only, carries its own validity date, and does not get the 10% yearly discount. Clinic and Free plans cannot use NHCX.

Q: I registered my participant code but NHCX still says it is not included in my subscription. Why? A: On Hospital and Lab plans, registering a participant code and processing transactions are separate entitlements. Buy the annual NHCX subscription (or check that it has not expired), then sign out and back in — the entitlement is read at login, so an existing session will not see it until you re-login.