- Dedicated TPA Desk module tracks pre-auth requests, queries, and claim settlements in real time.
- Automated rate chart validation enforces agreed insurance tariffs for procedures and bed charges.
- Claim deduction ledger highlights short payments and query reasons for quick resolution.
Cashless TPA insurance claims account for over 60% of hospital revenues in modern private healthcare. Stalled pre-authorizations, missing discharge documents, query delays, and tariff discrepancies can lock millions of rupees in unpaid claims and severely damage hospital cash flow.
1. Digital Pre-Authorization & Query Tracking Desk
The TPA Management Desk in H-ERP provides a single unified dashboard to handle initial pre-authorization forms, enhancement requests, and approval letters across multiple insurance providers and Third-Party Administrators (TPAs).
- Real-Time Approval Alerts: Automated notifications alert the TPA desk when IPD billing approaches approved credit limits.
- Document Attachment Vault: Upload patient insurance cards, diagnostic reports, and doctor clinical summaries directly to the claim file.
2. TPA Tariff Chart Validation & Package Enforcers
H-ERP stores pre-negotiated package rates and bed cap limits for each insurance provider, preventing non-payable billing items from being added to cashless invoices.
Digitally attaching pre-authorization letters to IPD deposit ledgers prevents discharge hold-ups and speeds up final TPA claim submissions.
3. Claim Reconciliation & Short Payment Recovery
Track submitted claim batches, approved payout amounts, and deductions automatically. Detailed reconciliation reports highlight reasons for claim disallowance, enabling billing teams to re-file disputed amounts promptly.
4. Best Practices for Optimizing Hospital Cashless Collections
Establishing standardized workflows between emergency registration, ward billing, and the TPA desk ensures that initial pre-authorization forms are dispatched within 2 hours of patient admission.