Hospital claim management software in Tamil Nadu

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.

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.

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.

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.

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.