Saturday, August 22, 2020

eClaims - Payer eObjects









This document presents the design specifications for electronic claim objects and associated standard processes for their exchange between Payers and Providers, through a Health Claim Platform that was recommended in the report “Common IT Infrastructure for Health Insurance Claims management” by IRDA-NHA joint working group. 

The health claim platform is intended to improve current claim processes, enforce transparency and facilitate on time provider payments for Health insurance Claims in India. Usage of Standard Electronic Claim related objects will facilitate auto adjudication of claims by both Public and Private Health Insurance Payers with reduced operational costs.



eDischarge Summary Object: Pick the eDischarge Object from Provider eObjects v2

Standard Value Sets for eClaims Objects

Standard Value Sets for eDischarge Objects

Summary of Insurance eObjects

The eObjects concept was introduced by ACCESS Health in Theme papers in Nov 2018, that became the Chapter 5 of the book ‘Health Systems for New India’, published by Niti Aayog in Nov 2019. Prof Dennis Streveler and Dr Pankaj Gupta are the Authors of the Chapter 5 in the Health System for New India book. The eObjects concept was again recommended in the ‘NHA-IRDA joint working group report’ to facilitate electronic, codified data exchange between providers and payers. The eObjects concept was then detailed out into Provider and Payer eObjects including the data standards recommended in the National Digital Health Blueprint. ACCESS Health has now released the eObjects design and code in opensource under MPL 2.0 license.

eObjects are evolving, check with us for the latest versions. Reach out to us for any help to understand or implement the eObjects. We can set up a group call with all of you to explain these eObjects in detail or even can set up one to one calls.

Thank You for your continuous association with us.

-- ACCESS Health Digital --

Contact for Clarifications:
Access Health Digital
digital.health@accessh.org

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