Healthcare Ecosystem Solutions

NHCX Use Cases & Deployment Roles

Discover how Hospitals, TPAs, Health Insurers, and Diagnostic Networks leverage Nexa's FHIR R4 Bidirectional Gateway for instant paperless claim adjudication.

Providers

Multi-Specialty Hospitals

High-concurrency claim handling (10,000+ claims/day), multi-payer routing, and support for OPD + IPD + Pre-auth. Full audit trails and SLA tracking at any scale.

  • 10,000+ claims/day
  • Multi-payer routing
  • OPD + IPD + Pre-auth
Adjudication

Third Party Administrators

Automated adjudication workflows, query management, and payer API integration to cut claims processing time.

  • Adjudication automation
  • Query management
  • Payer API integration
Diagnostic Network

Pharmacy & Diagnostics

Cashless OPD claims, pharmacy claims, and lab result attachments without complex HIS integrations.

  • OPD cashless
  • Pharmacy claims
  • Lab result attachment
Payers

Health Insurers & Payers

Core policy system connection to NHCX, auto-adjudication, automated claim receipt, FHIR validation, and AI fraud detection/pre-screening.

  • Auto-adjudication
  • Fraud detection
  • AI pre-screening
Public Schemes

Government Health Schemes

Pre-built support for government programs including AB-PMJAY, CGHS, ESIC, and state government health insurance schemes.

  • AB-PMJAY ready
  • CGHS compliant
  • State scheme support
Tech Partners

HIS / EMR Vendors

White-label SDK integration to offer native NHCX compliance to end clients with a revenue share model and no self-built compliance layer.

  • White-label ready
  • SDK available
  • Revenue share model
Tailored Ecosystem Solutions

Empowering Every Participant in Digital Health

Purpose-built workflows for healthcare providers, insurers, and TPAs operating under India's Ayushman Bharat Digital Mission (ABDM).

HOSPITALS & CLINICAL NETWORKS

Instant Cashless Pre-Authorization

Eliminate manual paper-based approval delays. Submit pre-auth requests directly from your HIS and receive adjudication responses in real time.

  • Sub-15 minute pre-auth approvals directly in HIS
  • 40+ pre-built connectors for Indian HIS platforms
  • Automated attachment & bill bundle generation
THIRD PARTY ADMINISTRATORS (TPAs)

Automated Claim Packet Processing

Accelerate claim packet verification with automated FHIR schema validation, digital signature checking, and instant status callbacks.

  • Automated validation against NHA FHIR profiles
  • Webhook alerts for pre-auth and final claim packets
  • Reduced manual audit backlog by up to 75%
HEALTH INSURERS & PAYERS

Direct NHCX Network Ingestion

Connect your adjudication engines to the open NHCX protocol with Keycloak OAuth 2.0 authentication and automated response routing.

  • Seamless multi-tenant payer connectivity
  • High-throughput Java 21 Loom execution
  • Full audit logging and regulatory compliance
DIAGNOSTIC & LAB NETWORKS

Encrypted Diagnostic Document Attachment

Streamline lab report attachments and invoice submissions with AES-256 encrypted payload handling compliant with the DPDP Act.

  • Fast binary & PDF diagnostic report uploads
  • AES-256 end-to-end payload encryption
  • NHA-compliant HSM digital signatures

Ready to Go NHCX-Live?

Join leading hospitals, TPAs, and insurers already connected to the NHCX network via Nexa's powered bidirectional adapter.