nha-in/nhcx
Agent skills for building on the National Health Claims Exchange (NHCX), one per use case in episode order: nhcx-coverage, nhcx-insurance, nhcx-preauth, nhcx-claim, nhcx-payment, nhcx-communication and nhcx-reprocess. Each builds its use case into a hospital information system or a claims desk, held to the NHCX package's pinned FHIR bundles, and installs and runs alone.
Add the NHCX claim to a hospital information system or a standalone claims desk. Record the discharge (normal, LAMA, DAMA or death, with the surgery stage), file the claim (15) under the pre-auth's number, answer a claim query (161 on PMJAY) and read every answer (25, 26, 27, 291), held to the pinned bundles, including the LAMA collapse and the death rules. Starts by checking whether the app already files claims or records the discharge facts a claim needs, and whether the approved pre-auth it depends on exists, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for filing a claim, discharge variants, claim query answers, NHCX use cases B5, D9 and D10, flow steps F10 and F11.
Add NHCX communication to a hospital information system or a standalone claims desk. Receive the payer's CommunicationRequest, classify it as a query, a notification or a note, acknowledge notifications at once, and answer queries with the TaskBundle reply on the request's own thread, held to the pinned bundle. Starts by checking whether the app already receives payer messages or answers queries, and whether it keeps the pre-auth or claim a query is about, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for payer queries, notifications, the inbox, the communication reply, NHCX use case B4, flow steps F9b (communication payer) and F12b.
Add NHCX policy search and coverage eligibility (discovery, validation, benefits) to a hospital information system, or build it into a standalone claims desk, held byte for byte to the pinned bundles. Starts by checking whether the app already searches policies and checks cover, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for policy search, coverage eligibility checks, "is this patient covered", NHCX use cases A2, B1 and D3, flow steps F1 to F3.
Add the NHCX insurance plan (the payer's package master) to a hospital information system or a standalone claims desk. Request it once per facility and policy, parse both published shapes, reuse it across episodes, and quote treatment lines from it, held to the pinned bundle. Starts by checking whether the app already fetches a plan or quotes packages, and whether the coverage it depends on exists, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for the insurance plan request, the package master, package rates, quoting line items, NHCX use cases B2 and D1, flow steps F4 and F7.
Add NHCX payment notices to a hospital information system or a standalone claims desk. Receive the payer's PaymentNotice, match it to its claim by the claim number, record it once, and acknowledge it at once (workflow 17 on PMJAY, the notice's own id for a generic payer), held to the pinned bundle. Starts by checking whether the app already records NHCX payments or acknowledges notices, and whether it holds the filed claim a notice names, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for payment notices, settlement, UTR, payment acknowledgement, NHCX use cases B7 and D13, flow step F12.
Add NHCX pre-authorisation to a hospital information system or a standalone claims desk. Link the admission, capture the dossier, ask the auth-requirements ruling, send the pre-auth (12), answer a PMJAY query (19, 131), raise an enhancement (13), cancel (PC01) and ask for a predetermination, reading every answer (20, 21, 22, 23, 24, PC02), held to the pinned bundles. Starts by checking whether the app already sends pre-auths or any of these legs, and whether the coverage and plan it depends on exist, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for pre-authorisation, enhancement, pre-auth query answers, cancelling a pre-auth, auth requirements, predetermination, NHCX use cases B3, B8 cancel, B9, D2 and D4 to D8, flow steps F5 to F9e.
Add the NHCX Task exchanges that follow a decision to a hospital information system or a standalone claims desk. Reprocess a rejected or partly paid claim (36), ask for the balance of a short payment (release, 36), and ask where a pre-auth or claim stands (status), reading the payer's answers (37 and the status Task), held to the pinned bundles. Starts by checking whether the app already sends these Tasks, and whether it holds the decided claim they act on, then builds, extends or reuses only what is missing. Self-contained; needs no other skill installed. Use for claim reprocess, arbitration, releasing a shortfall, status enquiries, NHCX use cases A5, B8 reprocess, D11 and D12, flow step F13.