TPA and insurance claim tracking
Track pre-auth, claim status and settlement for cashless and reimbursement cases.
Step by Step
- In the admission, open the Insurance tab.
- Record the TPA, policy number and pre-authorization amount.
- Mark cashless or reimbursement and track claim status.
- Attach claim documents; record co-pay and settlement on discharge.
The Claim Stages
Pre-auth → Approved → Settled → Received. Record the amount and reference at each stage, so the accounts team always knows what is pending.
Good Practice
- Raise an enhancement before the running bill crosses the approved amount.
- Explain co-pay, room-rent caps and non-payable items to the family in writing at admission.
- Collect documents during the stay: discharge summary, reports, prescriptions and implant stickers.
- Review pending claims weekly, TPA by TPA.
TPA and insurance tracking is part of the Hospital plan.
FAQ
- Who pays if the TPA approves less? The patient pays the shortfall, which is why written estimates at admission matter.
- Does insurance change the GST on the bill? No. Each service has the same GST treatment whoever pays.
Tip: still stuck? Message us on WhatsApp with a screenshot — most issues are solved in under 10 minutes.