TPA, insurance pre-authorisation and claims
Every pre-auth and claim, with how long it has been waiting.
The insurance desk records each request sent to an insurer, TPA, government scheme or corporate, and what came back. Each status change is a line on a timeline, so the desk can see at once which approvals are stuck. When a bill is settled, the insurer's share becomes a receivable and is aged until the money arrives.
| No. | Kind | Payer | Amount ₹ | Status | In status |
|---|---|---|---|---|---|
| PA-0412 | Pre-auth | TPA · Payer A | 1,80,000 | Submitted | 6 h |
| PA-0409 | Pre-auth | Insurer · Payer B | 95,000 | Query | 26 h |
| PA-0411 | Enhancement | TPA · Payer A | 40,000 | Requested | 3 h |
| CL-0231 | Claim | State scheme | 62,500 | Submitted | 9 d |
| CL-0219 | Claim | Insurer · Payer B | 1,28,000 | Short-settled | 2 d |
| CL-0214 | Claim | Corporate · Payer C | 34,000 | Settled | 5 d |
What changes on the floor
Billing and insurance. Included in: Hospitals, Hospital groups.
Nobody knows which pre-auths have been pending since yesterday
The worklist shows every pre-authorisation and claim with the hours it has spent in its current status, with a filter for overdue items.
The running bill overshoots the approved amount and nobody asks for more
The admission's insurance panel warns when the bill is more than ten percent over the approved total, and an enhancement is requested as a linked request.
Short payments by insurers quietly disappear
A receipt for less than the invoice leaves the shortfall on the ledger as short-paid. Only a manager can write it off, with a reason.
Rules the software enforces
These are checks in the product, with the reason shown to the person at the screen.
- RefusedSettling while approval is pending
A bill with a payer share cannot be settled until that share is approved and the patient's share is collected.
- CheckedThe payer share cannot exceed the balance
The insurer can never be shown as owing more than the bill.
- RecordedEvery write-off
Writing off a shortfall is limited to managers, needs a reason and is kept in the audit trail.
What is in it
Pre-authorisation
- Draft, submitted, query, approved, partly approved, rejected
- Enhancement requests linked to the original approval
- Approved-so-far total per admission
- The bill's payer share follows the approvals
Claims
- Draft, submitted, query, settled, short-settled, rejected
- Age in current status on every row
- Filters by status, payer and overdue
- Settlement writes the receipt to the ledger
Receivables
- Insurers, TPAs, government schemes and corporates as payers
- Receivable raised at settlement against the invoice
- Ageing: 0 to 30, 31 to 60, 61 to 90 and over 90 days
- Short-paid amounts tracked until received or written off
Questions hospitals ask
Does it submit claims to the insurer's portal?+
The desk submits on the insurer's or TPA's portal as it does today and records each step here. CuroMedica is the hospital's own tracker and ledger for every payer in one place.
Does it handle government schemes and corporate credit?+
Yes. A payer can be an insurer, a TPA, a scheme or a corporate, each with its own tariff class and ledger.
See insurance desk on your own setup.
A demo is set up with your departments, bed types and tariffs, so you see your hospital and not a sample one.