National Health Claims Exchange · Agentic AI Sandbox

One standardised rail for India’s health insurance claims

Integrate with NHCX faster with Agentic AI

A controlled, self-service sandbox where providers, payers and health-tech partners build and validate claims integrations with the National Health Claims Exchange. Instead of every hospital connecting to every insurer directly, participants exchange standard FHIR R4 bundles over NHCX. Purpose-built Agentic AI artefacts, assistants, code generators, simulators and validators, guide you through every step, from eligibility checks and pre-authorisation to claim submission and payment reconciliation, so you go live faster and with fewer errors.

Participant roles

One exchange, every claim

Provider

Hospitals, nursing homes & day-care/OPD clinics

Check patient coverage, raise pre-authorisation and submit claims to any registered payer over a single, standardised connection to NHCX.

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Payer

Insurers, TPAs, state agencies & govt. schemes

Receive standardised claim and pre-auth requests, respond with queries, approvals and payment notices, and settle faster with less manual paperwork.

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Policy Holders

Patients & policy holders

Experience transparent, trackable claims linked to an ABHA identity, with fewer delays between admission, discharge and settlement.

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Agentic AI Artefacts

AI assistants that do the groundwork of claims integration

The sandbox now has AI artefacts for NHCX Integration. Instead of reading claims specifications end-to-end, integrators describe what they want to build and the agents generate, wire up, test and validate the eligibility, pre-authorisation, claim and communication exchanges, compressing weeks of trial-and-error into guided, verifiable steps that take just days.

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WeeksDays

Move from weeks of trial and error to guided, verifiable steps across 4 claim stages and 6 AI artefacts.

Integration Assistant

A conversational agent that explains each claim flow in plain language, recommends the right APIs for your role, and answers specific questions in context.

FHIR & Payload Generator

Generates client code, FHIR R4 claim bundles, pre-auth requests and NHCX participant configuration in your stack of choice.

Payer / Provider Simulator

Spins up simulated payers and providers so you can run end-to-end eligibility, pre-auth, claim and payment scenarios in a fully simulated environment.

Standards Compliance

Validates your bundles against NHCX specifications and FHIR R4, flags gaps, and confirms readiness before you connect to live payers.

Debug & Error Explainer

Reads exchange responses and error codes, pinpoints the root cause, and suggests the exact fix, no more decoding cryptic claim rejections alone.

Go-Live Tracker

Tracks your progress, tells you what evidence each stage needs, and helps you prepare your participant onboarding and go-live submission.

The Claim Lifecycle

Four stages, end to end

An NHCX workflow moves through a standard sequence for one patient and payer. Integrators implement the stages relevant to their role, exchanging machine-readable, auditable and verifiable FHIR bundles at each step.

Coverage check

Eligibility

Confirm the patient’s policy, coverage and benefits against a payer before treatment begins.

Prior approval

Pre-authorisation

Obtain approval for the planned treatment, with support for enhancements and cancellation where needed.

Submit & reprocess

Claim

Submit the final claim for reimbursement, including newborn claims, and reprocess partially paid or erroneous claims.

Queries & notices

Communication

Respond to payer queries and track payment notices so both sides stay in sync throughout settlement.

Identity across every stage is anchored to the patient’s ABHA number, and each participant connects with a unique NHCX participant code.

PM-JAY on NHCX

The world’s largest government health assurance scheme is on NHCX

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana gives eligible families cashless secondary and tertiary treatment at empanelled hospitals. On NHCX it sits like any other payer, same cover, same cashless treatment, raised and settled through the exchange.

Know more about PM-JAY

₹5 lakh: Cover per family, per year · no premium at point of care
Cashless: At the hospital · claim raised over NHCX afterward

The Journey

From sandbox registration
to go-live: end to end

Here is the full lifecycle an integrator follows in the NHCX Agentic AI Sandbox. Each step is supported by the AI artefacts so you always know what to do next and whether you have done it correctly.

Onboard
Register & create your sandbox account
Step 1 of 6

Sign up as an eligible entity (provider, payer, TPA or health-tech), verify your organisation details, and accept the sandbox terms of use.
Once confirmed, access guided claim journeys and NHCX APIs for your role.
Access
Get your participant code & connect
Step 2 of 6

Receive your NHCX participant code, client IDs, keys and session tokens, then establish your first authenticated connection to the exchange.
FHIR & Payload Generator produces working auth code and your first eligibility request.
Build
Implement the core claim flows
Step 3 of 6

Integrate eligibility, pre-authorisation, claim submission and communication APIs as per the requirements of your solution and role.
Integration Assistant generates stage-based journeys, FHIR payloads, skill files and error scenarios.
Test
Simulate & validate end to end
Step 4 of 6

Run complete functional testing against simulated payers and providers, cover error paths, and ensure compliance against FHIR R4 checks.
Payer / Provider Simulator runs simulated claim workflows for end-to-end testing.
Certify · Go-Live
Onboard as a live participant
Step 5 of 6

Package and submit evidence of successful integration for review, then receive production participant access upon approval.
Go-Live Tracker assembles the evidence pack and readiness checklist; Assistant outlines the differences between sandbox and production.
Explore
Continue using the sandbox
Step 6 of 6

Keep using the sandbox after going live to test new claim scenarios, onboard new payers, join events, and explore new use cases.
Assistant surfaces new workflows, upcoming events and use cases you can explore in the sandbox.

Ready to start integrating?

Register for the NHCX Agentic AI Sandbox and let the AI artefacts guide you from your first eligibility check to go-live.