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IRDAI Cashless Rules and NHCX — The 1-Hour and 3-Hour Clock Every Hospital TPA Desk Works To
Since IRDAI's 2024 master circular on health insurance, insurers must answer a hospital's cashless request within 1 hour and approve the final bill within 3 hours of the discharge request. Claims are also moving to India's digital National Health Claims Exchange (NHCX). Both change how a hospital's insurance desk works.
Under IRDAI's Master Circular on Health Insurance Business (29 May 2024), an insurer must decide a hospital's cashless authorisation request within one hour and give final authorisation within three hours of the hospital's discharge request. If the delay goes beyond three hours, any extra amount the hospital charges is borne by the insurer, not the patient. Separately, the National Health Claims Exchange (NHCX), built by the National Health Authority under ABDM, is moving cashless claims between hospitals, insurers and TPAs onto one standard digital platform.
Last reviewed: 23 October 2026 · Treneywann Institute of Hospital Administration, Vyttila, Kochi
The Two Clocks: 1 Hour and 3 Hours
- Cashless authorisation — 1 hour. Once the hospital sends a complete pre-authorisation request, the insurer (or its TPA) must decide within one hour.
- Final authorisation at discharge — 3 hours. After the hospital sends the discharge request with the final bill and documents, the insurer must give final approval within three hours.
- Delays are the insurer's cost. If final approval takes longer than three hours, any additional amount charged by the hospital for the delay is borne by the insurer.
- In case of death, the insurer is expected to process the claim immediately so the body is released without delay.
The clocks only start once the hospital's request is complete. That is why the hospital side matters: a missing document, an unsigned form or a vague diagnosis pauses everything — and the patient waits at the billing counter.
Cashless Everywhere — Treatment at Non-Network Hospitals
The General Insurance Council's Cashless Everywhere initiative (January 2024) lets policyholders seek cashless treatment even at hospitals outside their insurer's network, with prior intimation — typically at least 48 hours before a planned admission, and within 48 hours of an emergency admission. A non-network hospital is not obliged to accept cashless, so front-office and TPA staff must explain clearly whether cashless is available or the patient will pay and claim reimbursement.
What Is NHCX — the National Health Claims Exchange?
NHCX is a digital claims exchange built by the National Health Authority (NHA) under the Ayushman Bharat Digital Mission (ABDM). Instead of each insurer and TPA having its own portal and paperwork, hospitals send pre-authorisations and claims in one standard digital format through the exchange, and insurers respond through it.
- Insurers and TPAs have been directed to onboard to NHCX.
- For hospitals, onboarding is being pushed strongly, but a blanket legal mandate on every hospital had not been confirmed at the time of review — check the latest IRDAI and NHA circulars.
- Hospitals that connect usually do it through their hospital management software (HMS), alongside ABDM registrations such as the Health Facility Registry.
What This Means for the Hospital TPA and Billing Desk
- Complete requests first time — policy details, ID, admission notes and estimate attached before sending, so the 1-hour clock starts immediately.
- Discharge papers ready early — final bill, discharge summary and investigation reports prepared before the discharge request, so the 3-hour window is not lost.
- Track every request against its clock and escalate to the insurer or TPA when a deadline passes.
- Explain cashless clearly at admission: network or non-network, Cashless Everywhere eligibility, and what the patient may have to pay.
- Know the schemes apart — private insurance follows IRDAI rules, while MEDISEP and PM-JAY / KASP have their own processes.
This is the daily work of a hospital TPA / insurance coordinator — one of the most in-demand entry roles in Kerala hospitals.
How Treneywann Teaches This
Treneywann updates its hospital administration curriculum as rules change. The IRDAI cashless rules and NHCX are taught as practical desk work — working to the 1-hour and 3-hour cashless clock, complete pre-authorisation and discharge files, Cashless Everywhere and NHCX-ready digital claims — within the insurance, TPA and billing training, with hands-on practice in India's only live Hinall HMS lab at Vyttila, Kochi.
See the hospital administration course and syllabus.
FAQs — IRDAI Cashless Rules and NHCX
How long does an insurer have to approve a cashless request?
Under IRDAI's Master Circular on Health Insurance Business (29 May 2024), the insurer must decide a hospital's cashless authorisation request within one hour of receiving it.
What is the 3-hour discharge rule?
The insurer must give final authorisation within three hours of the hospital's discharge request. If it takes longer, any additional amount charged by the hospital because of the delay is borne by the insurer.
When does the 1-hour clock start?
When the hospital submits a complete request. Missing documents or details pause the process, which is why accurate paperwork at the TPA desk matters.
What is Cashless Everywhere?
An initiative of the General Insurance Council (January 2024) that lets policyholders seek cashless treatment at hospitals outside their insurer's network, with prior intimation — typically 48 hours before a planned admission or within 48 hours of an emergency admission. Non-network hospitals are not obliged to accept it.
What is NHCX?
The National Health Claims Exchange — a digital platform built by the National Health Authority under ABDM that lets hospitals, insurers and TPAs exchange pre-authorisations and claims in one standard format.
Is NHCX mandatory for hospitals?
Insurers and TPAs have been directed to onboard. For hospitals, onboarding is strongly encouraged, but a blanket mandate on every hospital had not been confirmed when this page was reviewed. Check the latest IRDAI and NHA circulars.
Do these IRDAI rules apply to MEDISEP and PM-JAY?
The IRDAI timelines apply to health insurance policies regulated by IRDAI. Government schemes such as MEDISEP and PM-JAY / KASP have their own processes and portals.
Who handles cashless claims inside a hospital?
The insurance / TPA desk, working with billing, front office and medical records. TPA and insurance coordinator roles are common entry jobs for hospital administration graduates in Kerala.
Does Treneywann teach the IRDAI cashless rules and NHCX?
Yes. Treneywann updates its hospital administration curriculum as rules change, and the IRDAI cashless rules and NHCX are taught as practical work — working to the 1-hour and 3-hour cashless clock, complete pre-authorisation and discharge files, Cashless Everywhere and NHCX-ready digital claims — within the insurance, TPA and billing training, with practice in the live Hinall HMS lab at Vyttila, Kochi.
Sources and further reading
Summarised from IRDAI's 2024 master circular on health insurance as widely reported, and NHA/ABDM material on NHCX. Always follow the current circulars from IRDAI and the National Health Authority.
Want to Work in Hospital Administration?
Hospitals need administrators who understand insurance, records, compliance and patient services. The 1-Year Hospital Administration Course is ₹64,000; the 6 Months Hospital Administration Course (for healthcare professionals) is ₹42,000 — next batch 9 November 2026 at Vyttila, Kochi, with 100% Placement Assurance.
