Hospital Insurance & TPA Software,
Accelerating Cashless Approvals & Payouts.
Empower your hospital’s TPA desk with automated pre-authorization forms, payer-specific rate tariff locks, digital claims dossier bundling, copay calculations, and dispute-free reconciliations.
Intelligent TPA Desk & Cashless Claim Suite
Designed to reduce patient discharge delays, eliminate claim repudiations, and streamline insurance company collections.
Rapid Cashless Pre-Authorization
Auto-fill standardized pre-auth requests with patient demographic data, diagnosis codes, procedure cost estimates, and clinical justification.
- ✓ 1-Click pre-auth form PDF generation
- ✓ Initial sanction tracking & enhancement requests
- ✓ Payer query notification management
Multi-TPA Agreed Tariff Master
Enforce negotiated package rates per insurance company (e.g. Star Health, Care, Medi Assist, Paramount) to prevent billing rejections.
- ✓ TPA-specific room & ICU ceiling rates
- ✓ Surgical package rate auto-capping
- ✓ Non-empaneled reimbursement rate fallback
Copay, Deductible & Patient Share
Automatically segregate non-payable medical items, gloves, disposable syringes, and copay percentages for clear patient settlement.
- ✓ Automated non-payable consumables breakdown
- ✓ Policy copay ratio calculation (10%, 20%)
- ✓ Zero dispute transparent discharge bills
Complete Claims Dossier Bundler
Compile discharge summaries, itemized hospital bills, lab investigation reports, radiology films, and pharmacy receipts into one click.
- ✓ 1-Click unified claim bundle compilation
- ✓ Barcoded patient identification on all pages
- ✓ Digital doctor signature certification
Claim Adjudication & Settlement Ledgers
Track submitted claims from submission to bank settlement. Reconcile TPA payment advice notes (remittance scrolls) with outstanding dues.
- ✓ TPA-wise outstanding claim aging buckets
- ✓ Disallowance & deduction analysis reports
- ✓ Remittance advice scroll auto-matching
Government Health Schemes (PM-JAY & CGHS)
Manage Ayushman Bharat PM-JAY packages, CGHS, ECHS, and State Government Arogyasri schemes with specific package tariff adherence.
- ✓ Scheme beneficiary verification and card logging
- ✓ Scheme package code mapping
- ✓ Scheme-compliant claims export formats
All 16 Insurance & TPA Sub-Modules
Every operational step from patient insurance policy verification to final settlement advice reconciliation.
Insurance Company Master
Maintain registry of primary insurance companies, contacts & empaneled terms.
TPA Entity Master
Configure Third-Party Administrator relationships, portal URLs & desk contacts.
TPA Tariff Sheet Master
Configure customized room, procedure & consultation agreed rate sheets.
Pre-Auth Request Generator
Standard pre-authorization form with auto-filled clinical justification.
Enhancement Request Desk
Submit supplementary cost increase requests during prolonged IP stays.
Patient Policy Verification
Verify policy number, sum insured, corporate group ID & validity dates.
Cashless Admission Tagging
Tag IP admissions with approved initial sanction amounts.
Copay & Deductible Engine
Automated calculation of patient-payable deductibles and consumables.
Discharge Bill Itemization
Generate standard insurance-formatted itemized hospital bills.
Claims Dossier Bundler
Package discharge summary, lab reports & medicine receipts in one PDF.
Claim Submission Register
Track submitted claim dossiers with tracking numbers & dispatch dates.
TPA Query Response Desk
Log and manage queries raised by TPA medical scrutiny officers.
Remittance Scroll Matcher
Auto-reconcile bank NEFT scrolls with individual patient claim numbers.
Claim Disallowance Analytics
Analyze deductions, rejected items & short-settlements by insurer.
Public Scheme (PM-JAY) Desk
Handle Ayushman Bharat and state government health scheme beneficiaries.
Corporate Empanelment Desk
Manage direct corporate credit arrangements, MOUs & employee rosters.
5-Step Cashless Claim & Settlement Lifecycle
Standardized hospital insurance procedure ensuring rapid approvals and zero financial disputes at discharge.
Pre-Auth Request
TPA desk generates pre-auth form with patient ID, estimated treatment cost & clinical notes on admission.
Initial Sanction
TPA issues initial approval letter; hospital sets initial credit limit and proceeds with clinical treatment.
Stay & Running Bill
All procedures, ICU days, lab tests, and medications are billed in real time against approved TPA tariffs.
Final Approval & Discharge
Final bill dossier submitted to TPA; final sanction received, patient settles copay/deductibles and is discharged.
Remittance Settlement
TPA releases payment to hospital bank; system auto-matches remittance scrolls and closes open receivable ledgers.
Hospital TPA Desk & Claims Monitor
Real-time tracking of active cashless admissions, pre-authorization statuses, and claims awaiting remittance.
| Claim Ref / UHID | Patient Name | TPA / Insurance Co. | Diagnosis / Procedure | Bill Amount | Sanction Amount | Desk Status |
|---|---|---|---|---|---|---|
| CLM-2026-9921 UHID: HERP-8812 |
Ramesh Chandra (M/56) | Medi Assist (Star Health) | Coronary Angioplasty (PTCA) | ₹1,85,000 | ₹1,75,000 | Final Approval Granted |
| CLM-2026-9922 UHID: HERP-8819 |
Sunita Saxena (F/48) | Paramount TPA (Care Health) | Laparoscopic Cholecystectomy | ₹62,000 | ₹50,000 | Discharge Bill Under Scrutiny |
| CLM-2026-9923 UHID: HERP-8825 |
Vikram Malhotra (M/62) | Vidal Health (HDFC ERGO) | Total Knee Replacement (TKR) | ₹2,10,000 | ₹1,50,000 | Enhancement Requested |
| CLM-2026-9924 UHID: HERP-8830 |
Anand Verma (M/39) | MDIndia Healthcare (Niva Bupa) | Dengue with Thrombocytopenia | ₹38,000 | ₹35,000 | Initial Sanction Approved |
| CLM-2026-9925 UHID: HERP-8838 |
Kusum Devi (F/67) | Ayushman Bharat (PM-JAY) | Cataract Surgery with Foldable IOL | ₹18,000 | ₹18,000 | 100% Scheme Approved |