Questions hospitals actually ask us.

Data setup for your payer masters and tariffs, connecting your hospital system, configuring document checklists per payer, and training the TPA desk. Payer onboarding is quoted separately because the effort differs enormously between an exchange-connected insurer and a TPA that still works over a portal.

Under the Digital Health Incentive Scheme, hospitals can receive ₹500 per claim or 10% of the claim amount, whichever is lower, for claims processed through NHCX. The incentive is paid to the hospital. Scheme terms change, so confirm the current position with the National Health Authority before you build it into a business case.

The claim still goes. Caresoft Claim Manager routes by payer: the exchange where the payer is live, a direct API adapter where they have their own interface, and assisted portal submission where no interface exists. In the last case the system assembles the complete claim set and the outcome is recorded back against the case, so your reporting stays whole either way.

NHCX, the National Health Claims Exchange, is a digital gateway built by India's National Health Authority in consultation with IRDAI under the Ayushman Bharat Digital Mission. It went live in June 2024. It routes health insurance claims between hospitals, insurers and TPAs in a standard FHIR format, so a hospital submits once instead of working a separate portal for each payer. The exchange reads only the routing headers — the clinical and financial payload is encrypted end to end.

Two stages: sandbox testing and certification, then production credentials and a participant code. The sandbox work is the part with real variability, because it depends on how quickly your ABDM identity and your payer's own readiness line up. We do the technical side; the hospital owns the registration.

Yes. A hospital needs a Health Facility Registry (HFR) identity before it can transact on the exchange, and the ABDM milestones sit behind that. If you are already on a Caresoft hospital system, most of that groundwork is shared with work you have done or are doing for ABDM.

No. It sits alongside it. The final bill, patient and policy details come from your HIS; the claim status, approved amount and deductions go back to it. If you run Caresoft HIS the connection is built in. Other systems connect through the same push API.

When a payer responds, the adjudication comes back per bill line, not just as a total. Each disallowance is stored against the line it hit, with the payer's reason code, and classified — room rent proportionate deduction, non-payable item, tariff excess, co-payment, sub-limit, documentation. You can then see which payer, which reason and which department is costing you the most over a period.

Three levels. Caresoft manages the hospitals on the platform. A hospital administrator manages their own users, working rules and document checklists. Claim executives work the claims themselves. A hospital can never see another hospital's data — access is filtered by hospital on every query, not just hidden in the interface.

In India. Caresoft Systems holds CMMI Level 5, ISO 27001 and PCI DSS certifications. Claim payloads are encrypted end to end on the exchange, and the exchange itself never sees patient data.