Glossary

The terms this documentation uses, in the sense it uses them. Where NHA's documents use a term differently from ordinary English, the NHA sense is given.

Organisations and programmes​

• ABDM. Ayushman Bharat Digital Mission. The national digital health programme under which NHCX is built.
• SNOMED CT, ICD, LOINC. The clinical, diagnosis and laboratory terminologies FHIR bundles carry, alongside the NRCeS value sets for claim-specific codes.
• NHA. National Health Authority. Publishes the NHCX specifications, runs the exchange, and administers PMJAY.
• NRCeS. National Resource Centre for EHR Standards, at C-DAC Pune. Publishes the FHIR profiles and value sets NHCX bundles must follow.
• IRDAI. Insurance Regulatory and Development Authority of India. Consulted on the specifications; the registry insurers and TPAs are identified by.
• PMJAY. Pradhan Mantri Jan Arogya Yojana, the Ayushman Bharat health assurance scheme. On NHCX it is a payer with scheme-specific rules.
• SHA. State Health Agency. Administers PMJAY in a state; under the trust model, the payer for that state.
• TPA. Third-party administrator. Processes claims on an insurer's behalf; on the network it behaves as a payer and is the processor for the policies it handles.
• ISNP. Insurance self-network platform; an insurance marketplace, a participant role with aggregated or consented data access.
• BSP, EUA. Beneficiary service provider, end-user application. A patient's personal health record app registered as a participant to receive notifications.

PMJAY systems and roles​

• TMS. Transaction Management System. NHA's provider and payer applications for PMJAY claims; the system an HMIS integration replaces on the provider side.
• BIS. Beneficiary Identification System. PMJAY's beneficiary register.
• HEM. Hospital Empanelment Module. PMJAY's hospital register; the HEM ID is mapped to the NHCX participant ID at go-live.
• PPD. Preauthorisation Processing Doctor. The payer-side role that adjudicates preauthorisations.
• CPD. Claim Processing Doctor. The payer-side role that adjudicates claims.
• CRC. Claim Review Committee. Decides appeals; its decision is final.
• HBP. Health Benefit Package. PMJAY's package master, from which a hospital's insurance plan is drawn.
• STG. Standard Treatment Guideline. A clinical protocol attached to a package, delivered as a questionnaire the provider must answer.

Identity and registration​

• ABHA. Ayushman Bharat Health Account. The beneficiary's health ID; sent without hyphens.
• HFR. Health Facility Registry. A hospital's registry; its HFR ID is the hospital's registry ID on the exchange.
• NIN, ROHINI. Other registries a participant may be identified by.
• Registry ID. A participant's identity in the registry it belongs to: HFR ID for a hospital, IRDAI ID for an insurer or TPA, client ID for an app.
• Participant ID, participant code. A participant's address on the exchange, in the form 1518@hcx. The part after the @ names the exchange instance.
• Client ID and secret. The ABDM sandbox credentials used to obtain an access token.
• Milestone 1, M1. The ABDM integration level, ABHA creation and verification, that must be complete before NHCX.
• Bridge URL, endpoint URL. The base address of a participant's callback server, registered on its participant record.
• Passcode. The one-time code sent to a participant's registered mobile to confirm creation or configuration in production.
• Processor, processingid. The participant that processes claims for a policy: the insurer itself or its TPA. The recipient of every claim-side message.
• Payer ID, payerid. The insurer's own participant code, named inside the bundle as the insurer.
• Member ID. The beneficiary's identifier on the policy.
• NPI, NIIP. Identifier types for a provider's HFR ID and a payer's registry ID inside a bundle.
• WASA. The security audit completed before ABDM production access.
• HTC demo. The demonstration before NRCeS, IRDAI, TCS and NHA that closes sandbox certification.

Messages​

• JWE. JSON Web Encryption. The sealed-envelope format every message uses.
• JWT. JSON Web Token. The format of the access token and of the signature the exchange puts on calls to a participant.
• Envelope, protected header. The readable part of a message: the x-hcx- fields and the encryption settings.
• Letter, payload. The FHIR bundle inside the envelope, encrypted for the receiver.
• Domain headers. A few facts written on the envelope for the exchange's records, such as an amount.
• Correlation ID. The number that ties a request and its answers into one conversation.
• API call ID, request ID. Fresh identifiers for one call and one request.
• Workflow code, workflow ID. The number in the envelope that says which step of the claim a message is.
• Status word. The x-hcx-status value: request.initiated, response.partial, response.complete, response.error, and the exchange's own request.queued, request.dispatched, request.stopped.
• Receipt. The 202 Accepted body returned on taking a message in. Not a decision.
• Protocol response. A refusal returned on the callback with response.error and error details, when a message could not be opened or failed validation.
• Callback. The endpoint a participant hosts to receive answers and payer-initiated messages.
• Dummy payer. The sandbox payer, participant 1000003538@hcx, that answers the provider exchanges listed in the NHCX Use Cases chapter.

Claims​

• Preauthorisation, preauth. Approval to treat, sought before treatment. A Claim with use = preauthorization.
• Enhancement. Additional procedures or days sought against an approved preauthorisation.
• Resubmission. A revised preauthorisation that replaces an earlier one.
• Query. The payer asking for more before it decides. The case stays open.
• Claim. The request for payment after discharge. A Claim with use = claim.
• Adjudication. The payer's decision on a preauthorisation or claim.
• Reprocess. An appeal against a rejection, raised as a Task.
• Shortfall. A request for the difference when a claim was paid short, raised as a Task after payment settles, under reason partialpayment.
• Erroneous claim. In the value set, a separate reason, erroneousclaim, for a reprocess caused by a mistaken submission by the provider. The FAQ uses the phrase for the shortfall case; the two senses coexist in the corpus.
• Task. The general-purpose request resource: plan fetch, cancel, reprocess, search, payment notice, acknowledgement, communication.
• Communication. A payer-initiated message outside the claim's own request-and-answer: a TAT alert, a grievance, a wallet or policy change, a request for information.
• TAT. Turnaround time. The window within which a payer is expected to act; under some policies, silence within it means approval.
• Wallet. The beneficiary's remaining cover under PMJAY, shared across the family.
• Package. A treatment with a fixed rate under a scheme; the unit a PMJAY claim is built from.
• Stratification. A higher bed category, such as ICU or HDU, allowed as an add-on over a package rate.
• Implant. A device allowed as an add-on over a package rate.
• Unspecified procedure. A treatment not in the package list, allowed under conditions with a free-text name and amount.
• Cyclic procedure. A treatment approved once and delivered over several visits, such as dialysis.
• LAMA, DAMA. Leave against medical advice, without informing the hospital; discharge against medical advice, with a signed undertaking. Two of the four discharge types, with DTH (home) and DTM (death).
• LM100. The single line item for a LAMA or DAMA stay before surgery, in place of the approved packages.
• UTR. Unique transaction reference. The bank's reference for a payment, carried on the payment reconciliation.
• TDS. Tax deducted at source, itemised on the payment reconciliation.