Question 1

What is the Nexa NHCX Bidirectional Adapter?

Accepted Answer

The Nexa NHCX Bidirectional Adapter is enterprise-grade middleware that bridges legacy Hospital Information Systems (HIS) and modern EMRs directly to India’s National Health Claims Exchange (NHCX). It eliminates manual portal data entry by automating the entire claims lifecycle — from eligibility checks to final settlement — through real-time FHIR R4 APIs.

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Question 2

Does Nexa replace our existing Hospital Information System (HIS)?

Accepted Answer

No. Nexa works alongside your existing HIS. It acts as a translation layer that converts your internal billing and clinical data into NHCX-compliant FHIR R4 bundles, sends them to the network, and pushes back status updates (approvals, rejections, queries) into your system without altering your core clinical workflows.

Question 3

What is the cost structure for Nexa’s adapter?

Accepted Answer

Nexa offers flexible licensing models tailored to your stakeholder type: annual subscriptions based on claim volume for hospitals and TPAs, revenue-share developer licensing for HIS/EMR vendors via our White-Label SDK, and enterprise gateway licensing for insurance payers. Contact our team for a custom quote suited to your bed strength or monthly volume.

Question 4

What is the typical implementation timeline for Nexa?

Accepted Answer

Implementation typically takes 8–16 weeks for a standard HIS integration, depending on the complexity of your internal data models and the volume of clinical packages. Since Nexa handles the heavy lifting of NHCX protocol compliance, your team focuses primarily on internal data mapping rather than decoding NHA specifications.

Question 5

What is the "30-Minute Configuration Wizard" for?

Accepted Answer

The wizard automates the initial setup of Keycloak IAM, NHCX operator credentials, and multi-payer routing rules. Instead of writing custom code for authentication and endpoint configuration, your IT team can launch a live connection to NHCX in under 30 minutes using our guided onboarding interface.

Question 6

How do I get started with Nexa?

Accepted Answer

Getting started is simple. Contact our integration team for a sandbox demo and a technical architecture review. We’ll map your current HIS capabilities to NHCX requirements and provide a clear rollout plan. Visit our contact page or request a discovery call to begin.

Question 7

Can Nexa handle both Government (PMJAY/CGHS) and Private Commercial Insurer claims?

Accepted Answer

Yes. Nexa is built to be payer-agnostic. It supports the specific NRCES profiles required for AB-PMJAY and state schemes, as well as the private insurer-specific FHIR mappings mandated by IRDAI and NHCX. One adapter connects your hospital to the entire ecosystem.

Question 8

Does Nexa support government schemes like CGHS and ESIC alongside PMJAY?

Accepted Answer

Yes. Nexa includes pre-built mapping profiles for AB-PMJAY, CGHS, ESIC, and major state health schemes. The adapter automatically routes claims to the correct payer logic and handles the specific tariff, package rules, and pre-authorization conditions required by each government program.

Question 9

Can Nexa support OPD and Pharmacy claims, not just IPD?

Accepted Answer

Yes. Nexa is built for multi-modal claims. It supports high-volume, low-value OPD claims from outpatient clinics, pharmacies, and diagnostics labs, as well as complex IPD pre-authorizations and surgical packages. The adapter scales dynamically to handle the distinct payload structures required for OPD vs. IPD workflows.

Question 10

Can Nexa handle multi-state portability for PMJAY patients?

Accepted Answer

Yes. Nexa is designed for inter-state portability flows. It correctly routes claims across different State Health Agencies (SHA) and central payers, handling the unique tariff, empanelment packages, and package mapping requirements for portability cases.

Question 11

How does Nexa handle Pre-Authorization (Pre-Auth) workflows?

Accepted Answer

Nexa automates the Pre-Auth lifecycle: it constructs the CoverageEligibilityRequest or PreAuthBundle based on your admission data, submits it to NHCX, tracks the status via real-time callbacks, and notifies your desk of approvals, rejections, or queries — all in real-time, eliminating portal logins.

Question 12

What happens if a claim is queried (rejected for more info) by the insurer?

Accepted Answer

Nexa monitors NHCX callbacks in real-time. When a query is raised, Nexa parses the FHIR response, extracts the specific missing data requirements, and pushes a structured alert back into your HIS workflow. Your staff can respond, and Nexa resubmits the corrected bundle automatically.

Question 13

How does Nexa handle payment reconciliation and final settlement?

Accepted Answer

Once the claim is paid, NHCX sends a ClaimResponse or PaymentNotice bundle. Nexa parses the adjudicated amounts, deductibles, and payer contributions, and pushes this data back into your HIS billing module to automate your financial reconciliation and reduce manual bank-matching.

Question 14

What is Nexa’s handling of "Auto-Approval" and "Auto-Rejection" timers?

Accepted Answer

Nexa includes a state-machine engine that monitors published turnaround times (such as the IRDAI 3-hour cashless discharge guidelines and PMJAY auto-decision windows). If an auto-approval occurs, Nexa captures the success response. If auto-rejection is imminent, Nexa triggers proactive alerts to your claims desk.

Question 15

How does Nexa support the PMJAY "Six-Stage" Gated Claim Process?

Accepted Answer

Nexa enforces the TMS/NHCX gating logic internally. It ensures that Registration happens before Pre-Auth, and Pre-Auth is complete before Claim Submission. It also tracks strict timelines (e.g., 48-hour pre-auth initiation window) and alerts your team if a case is at risk of auto-rejection.

Question 16

How does the Nexa adapter differ from a standard HIS plugin?

Accepted Answer

Unlike static plugins, Nexa’s adapter is a bidirectional gateway that handles both outbound (HIS → NHCX) and inbound (NHCX → HIS) messaging. It manages asynchronous callback endpoints, signed/encrypted envelopes, and state-machine tracking for complex claim workflows (e.g., Pre-Auth ↔ Claim ↔ Payment Notice).

Question 17

How does Nexa help Third-Party Administrators (TPAs) reduce processing time?

Accepted Answer

For TPAs, Nexa automates the query management loop. When a payer raises a query, Nexa parses the FHIR response and pushes it directly into your adjudication workflow. Our pre-screening validation also flags likely rejections before they happen, reducing manual review cycles and accelerating final settlement.

Question 18

How does the "White-Label SDK" work for HIS/EMR Vendors?

Accepted Answer

Nexa offers an embeddable SDK that allows HIS vendors to add NHCX compliance to their own products without building the gateway from scratch. You get a revenue-share model, pre-built NHA certification support, and a dedicated partner desk, allowing you to sell "NHCX-Ready" as a native feature of your software.

Question 19

What deployment models does Nexa support?

Accepted Answer

Nexa can be deployed on-premise (within your hospital/TPA’s data center for maximum control and data sovereignty), in a private cloud, or via a managed SaaS model. We tailor the architecture to your IT security policy and DPDP compliance requirements.

Question 20

What does the "Dedicated 24/7 Technical Desk" include?

Accepted Answer

Our team provides round-the-clock support for critical production incidents, including claim routing failures, gateway connectivity drops, or urgent NHA compliance queries. You get direct access to principal systems engineers who understand both NHCX protocols and your technical stack.

Question 21

What kind of SLA and technical support does Nexa provide?

Accepted Answer

Nexa offers tiered SLAs (Platinum/Gold/Silver) with guaranteed response times under 15 minutes for critical production incidents. In addition to 24/7 incident response, our engineering team provides proactive health monitoring, scheduled maintenance windows, and regular protocol sync reviews.

Question 22

Do you provide sandbox access and NHCX certification support?

Accepted Answer

Yes. Nexa provides dedicated sandbox environments aligned with NHCX testing protocols. Our team supports you through the full certification journey: sandbox integration testing, NHA compliance review, and production rollout validation.

Question 23

How quickly can we get sandbox access for testing?

Accepted Answer

You can request sandbox access through our partner onboarding desk. Our lead solutions architects typically respond within one business day (IST, Mon–Fri) to provision your isolated sandbox environment and provide API documentation and testing bundles.

Question 24

What is the "Immutable Audit Trail" and why is it important?

Accepted Answer

Every claim transaction (forward and reverse) is logged with a unique correlation ID in an append-only audit log. This provides full traceability for regulatory audits (NHA/IRDAI), internal financial reconciliations, and rapid dispute resolution. No claim status can be altered or deleted once logged.

Question 25

How does Nexa comply with the DPDP Act 2023?

Accepted Answer

Nexa is built with Privacy-by-Design. We implement strict Role-Based Access Control (RBAC) via Keycloak, encrypt all Personally Identifiable Information (PII) at rest (AES-256) and in transit (mTLS), and ensure that patient data is never stored in gateway logs — only transaction metadata is retained for audit purposes.

Question 26

How does Nexa achieve sub-200ms latency for high-volume claim submissions?

Accepted Answer

Nexa leverages Java 21 Virtual Threads for lightweight concurrency and Redis-backed asynchronous queuing to handle bursts of up to 10,000+ claims per day without blocking. This ensures that even during peak admission hours, your HIS remains responsive while claims are processed in the background.

Question 27

What FHIR version and profiles does Nexa support?

Accepted Answer

Nexa is built on HL7 FHIR R4 and strictly adheres to the National Health Authority (NHA)-published India-specific FHIR profiles for claims, pre-authorization, and eligibility checks. We use HAPI FHIR for schema validation to ensure zero-error payload construction.

Question 28

What is the significance of "HAPI FHIR R4 Schema Validation" in Nexa’s pipeline?

Accepted Answer

We use HAPI FHIR to strictly validate every payload against NHA-published India-specific FHIR R4 profiles before submission. This "zero-error" pre-screening prevents costly rejections due to structural errors, ensuring that only compliant, adjudication-ready bundles reach the NHCX network.

Question 29

How does Nexa handle the "Signed and Encrypted Envelopes" required by NHCX?

Accepted Answer

NHCX requires every message to be sealed for a specific recipient using keys from the Participant Registry. Nexa automates this process: we fetch the correct registry keys, sign the FHIR bundle, encrypt it, and attach the routing headers. Your HIS simply receives a "ready-to-send" JSON payload.

Question 30

How does Nexa handle data security and encryption across the stack?

Accepted Answer

Security is non-negotiable in health claims. Nexa implements mTLS (Mutual TLS) for transport layer security across all gateway communications, AES-256 encryption for sensitive payloads at rest and in transit, Keycloak-based IAM with OAuth 2.0 and JWT tokens, and full compliance with the Digital Personal Data Protection (DPDP) Act 2023.

Question 31

How does Nexa handle "Multi-Payer Routing" and Failover?

Accepted Answer

Nexa acts as an intelligent router. You configure your preferred payer/insurer mappings once. If a primary insurer’s NHCX endpoint is down or experiencing high latency, Nexa automatically triggers failover policies, circuit breakers, and retries, ensuring no claim is lost due to temporary network outages.

Question 32

How does Nexa ensure "Zero-Downtime" during NHA specification updates?

Accepted Answer

Nexa’s architecture allows for hot-patching of FHIR profiles and protocol rules. When the NHA releases updates (e.g., new diagnosis codes or tariff changes), we deploy schema updates automatically without requiring your system to restart or undergo a full regression test cycle.

Question 33

Can Nexa handle legacy HIS systems that don’t support modern REST APIs?

Accepted Answer

Yes. Nexa supports legacy integration patterns. If your HIS lacks REST APIs, we can integrate via database views, CSV exports, or HL7 v2 interfaces, translating that data into modern FHIR R4 bundles for NHCX submission.

Question 34

How does the Nexa adapter manage asynchronous callback endpoints?

Accepted Answer

Because NHCX operates on an asynchronous messaging model (acknowledging request receipt immediately, followed by decoupled adjudication callbacks), Nexa exposes resilient webhook endpoints that correlate inbound callbacks to the original request using correlation IDs, updating your HIS database automatically.

Question 35

How does Nexa prevent duplicate claim submissions during network timeouts?

Accepted Answer

Nexa enforces strict idempotency key tracking across all outgoing transactions. If a network interruption occurs during pre-auth or claim submission, our queuing engine checks whether an idempotency token has already been registered before retrying, preventing accidental duplicate billing or duplicate claim errors at the NHCX switch.

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Frequently asked questions

01What is the Nexa NHCX Bidirectional Adapter?

02Does Nexa replace our existing Hospital Information System (HIS)?

03What is the cost structure for Nexa’s adapter?

04What is the typical implementation timeline for Nexa?

05What is the "30-Minute Configuration Wizard" for?

06How do I get started with Nexa?

07Can Nexa handle both Government (PMJAY/CGHS) and Private Commercial Insurer claims?

08Does Nexa support government schemes like CGHS and ESIC alongside PMJAY?

09Can Nexa support OPD and Pharmacy claims, not just IPD?

10Can Nexa handle multi-state portability for PMJAY patients?

Have a question not answered here?

Partner With Nexa Health Tech

Engineered for Zero Disruption, Built for Scale

Zero-Disruption Integration

Enterprise-Grade Security

Sub-200ms Latency

Live Bidirectional Flow Architecture

FORWARD — CLAIM SUBMISSION

Provider

Nexa Adapter

NHCX Network

Payer

REVERSE — ADJUDICATION RESPONSE

Payer

NHCX Network

Nexa Adapter

Provider

Product Features & Platform Capabilities

HMIS

EHR

LIS

RIS

ABDM

NHCX

FHIR

Integration Layer

Integration Journey

Targeted Stakeholders & Use Cases

Why Nexa vs traditional integration

Trust & Compliance

India's Smartest
NHCX Bidirectional
Adapter