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HCX Specifications
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HCX Specifications
v0.7-Draft
Summary
Context
Introduction to HCX
Approach
Technical Specifications
Domain Specifications
Business Policy Specifications
Contributing to the specifications
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Summary
Current status, enhancements from previous version and anticipated future roadmap
Inspired by the recommendations of the Joint Working Group of NHA and IRDAI (2019), Health Claims Data Exchange (HCX) is an ambitious open source project that aims to define interoperable protocol specifications to enable a multi-party exchange of health claims information.
The HCXs can be thought of as routing switches or email gateways that facilitate communication with the desired level of consistency, security, privacy, and durability. However, unlike the internet or email, this protocol is defined for a specialized use case of exchanging health claims-related information between relevant actors - payors, providers, beneficiaries, regulators, observers, etc.

Current Status

The following table provides a summary of the existing specification versions and links to the respective documentation.
Version details
Description
Version - 0.6 (Baseline) | Release date - September 08, 2021 | Published documentation link | Github link | Consultation questions link
Base version of specifications. It was built by 60+ volunteers from across the healthcare ecosystem (including Insurers, Hospitals, TPAs, Insurance Technology players and Think tanks) as a part of a transparent, collaborative and open effort during July 2020-September 2021 and launched for public consultation on September 08, 2021. You can find the launch details and list of volunteers here.
Version - 0.7 (Draft) | Release date - January, 2022 | Published documentation link | Github link | Consultation questions link
Based on feedback from various ecosystem players on the baseline version and rigorous feasibility analysis with the NHA team on the adoption of the specifications in public scheme use cases, this version includes the following key enhancements over the baseline version:
  • Multi-party processing support through REDIRECT and FORWARD constructs
  • Initial support for digital encoding of policies using InsurancePlan FHIR profile
  • New APIs to support pre-determination cycle
  • Introduction of communication APIs to support additional information exchange during various claim cycles - pre-determination, pre-auth, or claims.
  • Introduction of status API to support fetching of the status of a submitted request
  • Search API definition deferred to future version to allow further deliberation
  • Simplification of Protocol Headers - identifiers and status
  • Standardisation of protocol errors
  • Restructuring, examples, and language modifications to enhance readability
Please note that this version contains cumulative documentation and can be used by itself.

Future roadmap

The following table provides details of future releases along with the key enhancements planned
Timeframe/Probable version
Potential inclusions
Q1 CY-2022
  1. 1.
    Notification facility to enable notifications to interested participants during different stages of processing cycles
  2. 2.
    Further detailing of the domain objects - descriptions, examples, etc.
  3. 3.
    Revised approach on Search APIs to allow discovery of claims related information and related access control rules
  4. 4.
    Model business policies in various operational areas
  5. 5.
    Guidelines on Technical Operations of the HCX network as indicated in key specifications.
Q2 CY-2022
  1. 1.
    Finalisation of search APIs
  2. 2.
    Enhancements to digital encoding of policies
  3. 3.
    Support for the reimbursement use case
  4. 4.
    Enhancements in model business policies in various operational areas
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Current Status
Future roadmap