What we are building
A claim startsas handwriting.
The exchange wants a structured, coded record. A ward runs on a case sheet and a ballpoint pen. We are building the layer in between — so nobody has to ask a doctor to type.
E11Type 2 diabetes · I10Hypertension
Implant · DES × 1 · 14 Mar
Atorvastatin 40 mg, at night
Before any of that
Nothing arrives in the same shape.
A case sheet, a lab report on a different pad, a prescription in shorthand, a scan someone photographed at the counter. Four formats, four hospitals, no two alike. Normalising that is most of the work of getting a hospital onto the exchange. That is the part we are building.
How it works
From the case sheet to the settlement advice.
Four steps. The first one is the one everybody skips.
Capture
The sheet as the clinician wrote it — photographed at the counter, or pulled from the HIS where it already exists.
Structure
Free text mapped to ICD-10 and packaged as a FHIR R4 bundle. Anything the payer will ask for and cannot find gets flagged here.
File
Submitted on the exchange with the pre-auth trail attached, so the payer gets the clinical basis and the claim in one message.
Follow
Queries answered against structured fields, short-payments traced back to the line that caused them, settlement matched to the UTR.
The exchange
One connection, and everyone is on the other side of it.
NHCX is the National Health Authority’s claims exchange, part of ABDM. Instead of every hospital wiring up to every insurer, each party connects once and the exchange routes between them. A structured claim is something the payer’s system can read, answer and pay against.
The platform
What actually sits between the ward and the payer.
Records come in however the hospital already produces them. They leave as one structured claim on the exchange, and everything that happens to it afterwards comes back down the same path.
Who it is for
Three parties, one claim between them.
The exchange only works if every side of it is holding the same record. Each of them needs something different from it.
Hospitals
The bedside does not change. The billing desk stops re-typing.
- Clinicians keep writing on the case sheet
- Discharge summary, implant invoice and pharmacy list gathered before the claim is filed
- Tariff and pre-auth checked while the patient is still admitted
- One connection to the exchange instead of a portal login per payer
Insurers
Claims that arrive readable, with the reasoning attached.
- FHIR R4 bundles, coded to ICD-10 before they arrive
- Pre-auth and enhancement requests carry the clinical basis with them
- Deficiency queries answered against the fields they refer to
- The same shape of claim from every hospital on the exchange
TPAs
One queue instead of one portal per insurer.
- Claims from every empanelled hospital in a single work list
- Documents requested and returned on the claim itself
- The same claim state visible to the hospital and the payer
- Settlement advice matched back to the claim and the UTR
Coming soon.
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