Glossary
API (Application Programming Interface)
A set of protocols, definitions, and tools that enable software applications to communicate with each other.
Beneficiary
An individual covered by a health insurance plan.
Claim
A formal request for payment from a healthcare provider to a payer for services rendered to a beneficiary.
Data Exchange
The electronic transmission of healthcare data between different entities, such as providers, payers, and patients.
FHIR (Fast Healthcare Interoperability Resources)
A standardised data format for healthcare information exchange.
HIPAA (Health Insurance Portability and Accountability Act)
A federal law that protects the privacy of individually identifiable health information.
Integration
The process of connecting your application with the HCX platform to enable communication and data exchange.
Open-Source
Software that is freely available for anyone to use, modify, and distribute.
Payer
An entity that pays for healthcare services, such as an insurance company or government agency.
Pre-Authorization
The process of obtaining approval from a payer for a specific medical service before it is rendered to the beneficiary.
Provider
A healthcare professional or facility that delivers healthcare services to patients.
SDK (Software Development Kit)
A collection of tools and libraries that simplifies the development of software applications for a specific platform.
TPA (Third-Party Administrator)
An organisation that manages claims processing and other administrative tasks on behalf of a payer.
Workflow
A sequence of steps followed to complete a specific task or process.
Beneficiary Service Platform (BSP)
Digital platforms dedicated for assisting beneficiaries to track and file claims.
Coverage Eligibility
Process of checking if the beneficiary's policy is in force and cover the proposed goods, products and services.
FHIR Profile
A JSON data structure that defines a domain model eligible to be carried as part of JWE payload in the HCX protocol APIs.
HCX Switch
Instance of the HCX gateway, implemented as per the HCX protocol, that facilitates the information exchange between its participants
HCX Network
Instance(s) of HCX and their participating systems governed by a common network policy
In-patient department (IPD)
Inpatient care, often referred to as the In-patient department (IPD), is a dedicated section within a healthcare facility specifically designed to deliver comprehensive medical care and treatment to patients or beneficiaries who require admission or an extended stay within the hospital
Network participants
Any platform that has implemented the HCX protocol and becomes the part of a network as above
Notification
A logical unit of information sent to relevant network participants. Notifications can be triggered by an event, activity or time trigger on the network.
Notify
Act of sending a notification
Outpatient department (OPD)
The Outpatient Department (OPD) is a distinct component of a healthcare facility, such as a hospital or clinic, dedicated to delivering medical services to patients who do not necessitate overnight hospitalization
Registry
A tamper proof, audited collection of entries with their provenance
Reimbursement
Service delivery context in which beneficiary initially pays for the service expenses to the service provider, and then seeking reimbursement from their respective paye
Schema
A JSON data structure that defines an entity as per OpenAPI 3.0 schema specifications
Template
Message structure with placeholder for context dependent data variable that helps in standardising the message parsing on the network
Technical Service Provider (TSP)
Organisation that offers specialised technical support, services, or solutions to assist HCX network participants like providers, payers. etc
Third party administrator (TPA)
Third-Party Administrator (TPA) in healthcare manages administrative tasks, such as claims processing and provider network management, on behalf of health insurance companies or self-funded employers
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