TPA and cashless claims, tracked file by file
Included in: Full Suite See pricing
* Sample data, illustrative
What the Mediclaim & TPA module does
TPA master
Maintain the third-party administrators you work with in one master list.
Pre-authorisation
Manage pre-authorisation for cashless admissions before treatment starts.
Cashless request per admission
Create and manage a cashless request against each IPD admission, so the claim lives with the patient's stay.
Cashless file dashboard
See counts of pending, outstanding and completed cashless files at a glance.
Submission, payment and rejection
Record when a file is submitted to the insurer, when payment arrives, and when a claim is rejected.
Linked to the IPD invoice
Mediclaim data is linked to the IPD invoice, so the patient's share and the insurer's share reconcile.
Claim form printing
Generate and print claim forms from the case.
In practice
No file left behind
Month-end, the accounts head opens the cashless dashboard: twelve files outstanding, three rejected. Each one opens to its admission, its pre-authorisation and its submission date, so the follow-up list writes itself instead of being assembled from the TPA desk's notebook.
Illustrative scenario.
Mediclaim & TPA questions
Can we track cashless claims per patient admission?
Yes. A cashless request is created against each IPD admission, and mediclaim data links to that admission's IPD invoice.
Does it show which claims are pending?
Yes. The cashless file dashboard shows counts of pending, outstanding and completed files.
Can rejections be recorded?
Yes. The module records cashless rejections alongside submissions and payments.
Does Tapti HMIS print claim forms?
Yes. Claim forms are generated and printed from the module.
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