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IHX is India’s largest healthcare data exchange platform.

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The company works with large insurance payers like Medi Assist, HDFC Ergo, Aditya Birla Health Insurance, Reliance General Insurance etc. IHX is driving digitization in the Indian health insurance market.

IHX is used by more than 12,000 hospitals 🏥 with an annual cashless claimed value of 💸INR 8000 crores 💸 being processed on the platform. The platform offers several propositions which focuses on:

• Patient experience
• Quicker claims adjudication
• Interoperability
• Delivering cost optimisation

The cost reduction is through a strong focus on digitization and reduction in the overall processing time.

How was the problem solved before?

Before IHX came into being, hospitals in India used to submit cashless claims to insurance companies by scanning the claim documents and sending them as attachments in emails to the insurers. This resulted in an extremely high manual effort on the part of insurers to receive those claims and digitize them on their side. This queuing of emails not only clogged the system but it also meant that some of the emails got lost and hence leading to very poor customer outcomes.

How IHX created a category and solved the tedious problem?

IHX solved this problem by enabling digitization of insurance claims at source. Hospitals can now upload their claims in the IHX platform and they can submit the claims to any insurer on the IHX platform in real time.

What it does is that it takes extremely less time to generate a claim ID for the patient. The claim statuses can be tracked in real time and the collaboration between the insurer and the network provider happens in a seamless and digital fashion.

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Claims Tech SaaS Market in India

👥 About the Competition

IHX is clearly a market leader. There are several small software companies which provide similar software applications to 50 to 200 hospitals. Some of the other competitors of IHX include ClaimBook and Remedinet. ClaimBook has approximately 250 hospital clients whereas Remedinet has about 400 hospital clients.

The business models of these software companies are also very different. While ClaimBook and Remedinet focus on monetizing from the hospitals i.e. a longer sales cycle trying to sell to thousands of hospitals, IHX on the other hand monetizes from the payers i.e. insurers.

🌟 What makes IHX different from it’s competitors? | Channel Acquisition for IHX

Rather than trying to tie up with thousands of hospitals, IHX is only selling its platform to 30-odd health insurance companies in India. This means that IHX gets a large bulk of transaction volume from onboarding a single insurer. This business model also means that IHX is used at the hospitals which are empanelled by the insurance company and hence it is the insurers who introduce IHX to hospitals. This gives IHX a lot of credibility versus other competing SaaS platforms. Also the fact that IHX is deeply integrated with the insurers, the claim experience of hospitals is the best in the entire industry.

🌐The Future

With the insurance sector regulator IRDAI mandating insurers to enable cashless hospitalisation even at a non-empaneled hospital (called as Cashless Anywhere), the landscape of potential IHX users has expanded manifold. India has about 30000 hospitals that are empaneled by one or the other insurers and there are another 60000 to 80000 big and small hospitals that are not in any insurer’s cashless network. This is a massive opportunity for IHX to flip the model and acquire hospitals on its own without relying on insurers to pass-on the list of empaneled hospitals to it.

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More on it when we do the Process Teardown...​

​🐬 For this project, I’m deep diving on IHX’s provider platform Onboarding journey i.e IHX Link: provider.ihx.in

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👥 Ideal Customer Profiles

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☎️ USER CALLS

👨🏻‍🦱 ICP 1 - Mr Ram

(TPA executive at Shri Balaji Action Hospital, Delhi)

Q: What challenges do you face when handling insurance claims?

A: The patient/caregiver comes to our desk with high curiosity seeking help with the admission process and filing a claim to their insurance company. We are always here to help and assist the patients with utmost ease and sincerity.

Today, we use to IHX to help us submit and track a claim. Sometimes, the patient details are not available in the portal, which leads to us sending a manual email with all documents attached.

This results in uncertainty in TAT for claim acknowledgment, status and further causes inefficiency in tracking the claim. The pressure of my job is peak when the claim is sent on email and I am unable to keep track and be answerable to my patient/caregiver with clarity.

Q: How much time do you spend on insurance claims daily, and how has IHX helped reduce this time? What is the average number of claims processed per user per day?

A: It is my daily job to use the IHX platform. That given, I spend anywhere between 6 to 8 hours of office hours. On avg average we have 120 patients actively admitted/ discharged on a daily basis and ~ 50% are cashless insurance patients on a normal day. My team (of 4 members sitting at the TPA front desk) and I submit and update claims for the patient through IHX for about 60 patients across different insurance payors. If I were to use email to track and manage emails for 60 patients everyday, my time to work and motivation to drive patient insurance engagement would dilute.

With IHX, it is easy to login through one single platform and manage everything at one place.

Q: What in you opinion, do you recommend in IHX to help you improve your productivity?

A: Often, there is attrition in the front end TPA desk team. Every quarter we have new employees joining in, and one of our time is blocked to train them on how submit, upload and file a claim. They also end up making errors while doing the job. If IHX could share a self paced learning/ demo video for these employees, our time would be used more effiencetly and help us improve our productivity. As I said, hospital always has heavy patient inflow and our core job is to help them. Spending my time else where, blocks my primary job and delays processes for patients claims.

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🧔🏻ICP 2: Mr Vimal Sirohi

(Revenue and Reconciliation Manager at Shri Balaji Action Hospital, Delhi)

Q: Do you find any aspects of your current process inefficient?

A: I use IHX every other day to access and view no of claims exchanged, transacted and the credit outstanding, i.e. money needed to collected from the insurance company or TPA (payer).

To manually search 60 claims daily across different payers and them match their settlement voucher, money recieved with the UTR shared is a tedious job.

My suggestion, if IHX was integrated with my hospitals HIS, this process would be more efficient saving me time and helping me focus on calculations correctly.

Q: How does the insurance process impact the hospital’s operations?

A: About 60% of hospitals cash flow is dependent on insurance credit. To be able to do my primary job quickly and receive timely updates from payer on payment and reconciliation will help the hospital utilise the money to fastrack supply and certain other operational costs. Today, we receive 70% of insurance money timely, the 30% is where I have to manually follow up with payers for payment release. Takes my time for a toss!

Q: What are the main benefits you seek from using IHX? How much time do you spend on insurance claims daily, and how has IHX helped reduce this time?

A: If we could have a feature to at-least upload the UTR and money received as an excel file on IHX and match against all transaction of claims exchanged over a certain time period, it would save my time. I spend about 2-3 hours on manually verifying each payment. I could use that time to regularly followup for delayed payments from payers and fastrack cash flow.

IHX however, has helped me save time of manually opening each email to keep track of settlement vouchers and them matching it. That would consume a half day time for me earlier.

💡 Process and Product Teardown

IHX onboarding .pdf

👆🏼Activation Metrics To Track
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Number of team members added

• Hypothesis: All team members added to an account increase the probability of activation.
• Details: Inviting other team members to use IHX indicates confidence in the product. When all team members are using the platform, it makes it harder for the team to switch platforms.

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• Hypothesis: Using more advanced features correlates with higher activation.
• Details: Advanced features might include MIS/reports, and integration with Hospital Management System (Hospital’s ERP). Usage of these features shows the user's commitment to leveraging the platform fully.

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• Hypothesis: A higher number of claims processed through the platform and minimal or zero claims processed through email submission indicates higher retention and activation.
• Details: If the operator uses IHX to process a large number of claims (vs email submission), it demonstrates effective use of the platform for its primary purpose.

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• Hypothesis: More time spent on the platform indicates higher retention and activation.
• Details: Time spent processing claims, checking claim status, responding to information requests by insurers, and using reporting features suggests that the user is deriving significant value from IHX.

• Hypothesis: Generating key reports at a regular frequency indicates higher engagement and activation.
• Details: Creating and analyzing reports on claim status, approval rates, and turnaround times suggests that users are actively using the data to improve their processes.

Metrics to Evaluate "Efficiency" of Onboarding Flow:

• Total count of hospitals opting for the Demo out of total hospitals empanelled during the same period
• Total hospitals getting activated on the platform
• Total users submitting their first claim
• Total hospitals adding and updating all their team members
• Total users using advanced features (such as MIS and detailed reports)

Metrics to Evaluate "Effectiveness" of Onboarding:

• D1, D7, and D30 retention: Tracking retention rates on day 1, day 7, and day 30.
• DAU/MAU: Daily Active Users vs. Monthly Active Users.
• Frequency of engagement: How often users interact with the platform.
• Average Turn Around Time (TAT) for claims
• User retention cohort: Analysing cohorts to understand retention patterns.

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