Health insurance in India is undergoing a transformative shift. The Insurance Regulatory and Development Authority of India (IRDAI) is leading this change by leveraging professional registries in health insurance. These registries provide a structured database of healthcare professionals. The IRDAI aims to utilise these registries to enhance transparency and efficiency.
Health insurers can access this data to ensure better health insurance policy administration. Utilising professional registries also helps in accurate claim processing and fraud prevention. So, both insurers and policyholders benefit from improved services and trust.
Let us explore how health insurance can leverage professional registries to achieve these goals.
What is the Healthcare Professional Registry (HPR) in India
The National Health Authority (NHA) has established the Healthcare Professional Registry (HPR) as part of the Ayushman Bharat Digital Mission. It is a comprehensive repository of registered and verified healthcare professionals who are authorised to deliver both modern and traditional healthcare services across India.
Under HPR, a Healthcare Professional ID (HPID) will be created using Aadhaar or other KYC documents. The medical qualifications of professionals will be verified by their respective State Medical Councils. The HPID serves as a unique identifier for medical practitioners, which enables connections with everyone involved in the healthcare ecosystem.
Read More:
Ayushman Bharat Health Account.
How IRDAI Protects Policyholders Interests
- Regulation and Supervision: IRDAI regulates and supervises insurance companies to ensure they operate fairly and transparently.
- Consumer Grievance redressal: Establishes mechanism for policyholders to address grievances.
- Standardisation of Policies: The law mandates standardised insurance products to simplify terms and conditions so that policyholders find them easy to understand.
- Ensuring Solvency: Ensures that insurance companies maintain adequate financial reserves to meet policyholder’s claims.
- Market Conduct: Monitors and enforces ethical practices among insurers to prevent misleading marketing and sales tactics.
- Public Awareness: Promotes awareness and education about insurance rights and obligations among policyholders.
Read More:
Policy for Protection of Policyholders’ Interests and Grievance Redressal Policy.
How Do Healthcare Professional Registry Simplify Healthcare Access
- Professional registries in health insurance simplify access with a verified database of professionals.
- It includes detailed information on doctors, nurses and other healthcare providers.
- Insurers can access this robust provider network.
- Streamlines the process of matching policyholders with appropriate services.
- Enhances trust and transparency with vetted professionals.
- Speeds up claim processing with verified provider information.
- Improves overall patient experience.
- Maintains healthcare system integrity.
- In future, patients will be able to find qualified providers directly.
Benefits of IRDAI’s Professional Registry in Health Insurance
Streamlining Insurance Processes
Professional registries simplify and streamline insurance processes by providing quick access to verified information. This aids in faster claim processing and policy administration. For all
types of health insurance, these streamlined processes result in quicker approvals and less hassle for policyholders.
Verification and Authentication
The professional registry ensures that all listed healthcare providers are verified and authenticated. The verification process involves:
Facilitating Provider Networks
Healthcare Professional Registries (HPR) in health insurance under the Ayushman Bharat Digital Mission help build efficient provider networks. Insurers can easily identify and connect with verified healthcare professionals.
This facilitates better coordination and policyholders' access to quality healthcare services. Whether it is individual health insurance or group health insurance, having a robust provider network is essential.
Encouraging Registration of Healthcare Professionals
The introduction of a professional registry encourages healthcare professionals to register and be part of a verified network. Benefits include:
- Boost in healthcare provider’s credibility.
- Ensures they meet necessary standards and qualifications
- Promotes professionalism and trust within the healthcare sector.
Enhanced Policyholder Experience
Insurers can leverage professional registry to enhance the experience for policyholders. Other benefits include:
- Verified and reliable healthcare providers ensure quality care.
- Improves overall satisfaction of health insurance policyholders.
- Streamlined processes contribute to a positive experience.
- Reduced risk of fraud and more reliability.
Unified Digital Services
A host of online benefits, including licence renewal, obtaining no-objection certificates and digital signatures. It also allows access to clinical decision support systems, telemedicine, digital health records and HMIS solutions. One can also get medical certificates, participate in Healthcare Workforce Mobility and download digital certificates.
Digital Transformation
The professional registry is a key component of digital transformation in the health insurance sector. It supports the Ayushman Bharat Digital Mission by integrating healthcare data into digital health records. This digital shift streamlines operations and enhances data accessibility.
Who All Can Register Themselves in the Healthcare Professional Registry
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Doctors: Medical practitioners with recognised qualifications can register to ensure their credentials are verified and authenticated.
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Nurses: Registered nurses with appropriate certifications can join the registry to validate their personal standing.
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Allied Health Professionals: Therapists, healthcare technicians and other allied health professionals can register and be part of the verified network by validating their qualifications.
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Pharmacists: Pharmacists holding valid licences can register to ensure their services are recognised within the healthcare system.
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Traditional Healthcare Practitioners: Practitioners of traditional medicine systems, such as Ayurveda, Homeopathy and Unani, can register themselves by verifying their credentials.
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Conclusion
Leveraging professional registries in health insurance significantly enhances the efficiency and transparency of the healthcare system.IRDAI's initiative to use these registries ensures accurate claim processing, fraud prevention and better policy administration. This benefits insurers and policyholders by streamlining processes and building trust.Access to a verified database of healthcare professionals helps insurers develop robust provider networks and ensure quality care for policyholders. The integration of these registries with digital health records further supports the digital transformation of the healthcare sector.Professional registries play an important role in improving the health insurance landscape in India.
Frequently Asked Questions
Can insurers access professional registries?
Yes, insurers can access the professional registry to verify the credentials of healthcare providers and streamline policy administration.
What impact does the professional registry have on claim processing?
The professional registry simplifies and speeds up claim processing by providing insurers with verified information. It also helps reduce delays and errors.
How does the professional registry affect the cost of health insurance?
The professional registry can potentially lower costs by reducing fraud and administrative errors. It can also help insurers achieve more efficient operations and better risk management.
What are the future prospects for the professional registry in health insurance?
The professional registry is expected to continue evolving by incorporating more data and features to further enhance the efficiency and transparency of the health insurance sector.