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.

eClaims Objects - Health Claims Platform

Payer eObjects Specifications: eClaims Object, Claims Response etc.

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

Social Entrepreneurship Accelerator [SEA]

ACCESS Health Digital [AHD] is a a not for profit think tank working on NDHB Digital Health Standards for India. We run a Social Entrepreneurship Accelerator [SEA] for helping Indian HealthTech startups and vendors to implement Open Digital Health Standards that are applicable globally. #AtmaNirbharBharat #VocalForLocal

SEA Silver Club

Silver Club has implemented the Standards and achieved our Stamp of Confidence.

http://www.openbodhik.in/2021/07/stamp-of-confidence.html

SEA implements the eObjects Interoperability framework. eObjects were first written by Prof Dennis Streveler and Dr Pankaj Gupta in a white paper in Nov 2018 that was published by Niti Aayog in the book Health Systems for New India, Chapter 5 - Reimagining India's Digital Health Landscape Wiring the Indian Health Sector in Nov 2019.

SEA Objectives

SEA Cohort 1

SEA Cohort 2

In late October 2020, India's National Health Authority' Market ACCESS Program [MAP] put 12 startups under mentorship of ACCESS Health Digital's Social Entrepreneurship Accelerator [SEA] -- the second of three cohorts to join the SEA family, now home to almost 40 startups that range in sector and specialty from primary care delivery and telemedicine to electronic health records and disease management. Like the previous cohort, SEA aims to provide its newest members with mentorship, market access, and a stamp of confidence, among other basic building blocks that will situate them in the digital health landscape. Together, they're working toward a single transformative purpose: building a vibrant national digital health ecosystem.

SEA Cohort 3

Parallelly Cohort 3 has also started to take shape, mostly on reference from Cohort 1 and requests from Partner organizations.

The Social Entrepreneurship Accelerator launched by ACCESS Health Digital has become an official Amazon AWS Activate Provider. AWS Activate works with accelerators, angel investors, and venture capital firms to provide startups with free AWS credits, technical support, training, resources, and more. These exclusive benefits are designed to help startups quickly get started on AWS and grow their business. Startups associated with an AWS Activate Provider are able to apply for AWS Activate Portfolio.

The new partnership with Amazon Web Services will help the Social Entrepreneurship Accelerator create new opportunities for its startups, providing them with access to Infrastructure as a service [IaaS], Platform as a Service [PaaS] and Software as a Service [SaaS]. This gives the startups entry into a Plug-and-Play integrated software development environment. Just adopt the PaaS and all startups in the accelerator can turn into SaaS companies.

SEA is an Exponential Organization (ExO) whose impact will be disproportionally large as compared to its peers because it leverages exponential technologies.