Cashless Hospitalization, TPA Pre-Auth & Payment Reconciliation.
Manage cashless admissions and insurance claims without paper confusion. Track pre-authorizations, file claims against the final hospital bill, and reconcile settled amounts cleanly in your ledger.
| SERVICE / ITEM DESCRIPTION | DEPARTMENT | AMOUNT (INR) | LINKAGE |
|---|---|---|---|
| General Ward Bed Charges (4 Days @ ₹2,200/day) | IPD | ₹8,800.00 | ✓ Auto-Charged |
| Dr. Kulkarni Consultation (3 Visits @ ₹800) | Doctor | ₹2,400.00 | ✓ Auto-Charged |
| Inj Ceftriaxone 1g IV (Batch #OCT26-B) x 6 | Pharmacy | ₹1,980.00 | ✓ Auto-Charged |
| Complete Blood Count (CBC) + Serum Creatinine | Lab | ₹1,150.00 | ✓ Auto-Charged |
| Chest X-Ray Digital (PA View) | Radiology | ₹750.00 | ✓ Auto-Charged |
| Nursing Care & Consumables Kit | Nursing | ₹1,400.00 | ✓ Auto-Charged |
What Your Hospital Can Do
Designed for everyday speed and simplicity across Indian hospitals and nursing homes.
Taking the Pain out of Cashless Hospitalization
As health insurance penetration grows in India, hospitals are handling an unprecedented volume of cashless claims. However, managing Third Party Administrators (TPAs) manually creates massive administrative overhead. Papers get lost, pre-authorizations are exceeded without the patient knowing, and reconciling the final bank settlement against the original bill is a tedious forensic exercise.
QureSetu's TPA module acts as a strict financial tracker. It ensures that the hospital never accidentally bills the patient for what the insurance covers, and never lets a patient leave without paying their required co-pay or non-medical consumables. When the TPA approves a specific limit, that ceiling is actively monitored against the patient's running bill.
The most powerful feature is the 'Receivables Dashboard'. Hospital owners can see exactly how much cash is locked in pending claims, grouped by specific TPA providers. When bulk payments arrive from an insurance company, accountants can easily distribute that bulk sum across multiple patient accounts, cleanly closing out ledgers and identifying any unfair deductions that need to be contested.
How it Works: Processing a Cashless Admission
1. Policy Verification
Patient arrives for a scheduled surgery. Front desk enters their Star Health TPA details. The system logs the policy number and expiry date.
2. Pre-Authorization
The billing team submits an estimated cost of ₹50,000 to the TPA. The TPA approves ₹45,000. This approval amount is logged in the system as the 'Pre-Auth Limit'.
3. Co-Pay Calculation
At discharge, the final bill is ₹52,000. The system automatically calculates that the TPA will cover the approved ₹45,000, and immediately asks the cashier to collect the ₹7,000 co-pay from the patient.
4. Claim Reconciliation
30 days later, a bank transfer arrives from the TPA for ₹44,000 (with a ₹1,000 deduction). The accountant marks the claim as 'Settled', writing off the deduction so the accounts balance perfectly.
"Tracking our pending TPA receivables used to be a nightmare of Excel sheets. We never knew exactly how much money was stuck in processing. Now, the TPA dashboard shows us our exact outstanding receivables and alerts us when a claim crosses 45 days pending."
Manish Agarwal
TPA Desk Manager
Agarwal Heart Institute
Frequently Asked Questions
Can we attach scanned documents to the claim?
Yes, you can upload scanned ID cards, pre-auth forms, and signed discharge summaries directly to the patient's claim record for easy retrieval.
How does the system handle non-admissible expenses?
The billing master allows you to flag specific items (like gloves, diet charges, registration fees) as 'Non-Admissible'. These are automatically pushed to the patient's cash co-pay portion during billing.
Can a patient have both an advance deposit and TPA coverage?
Yes, the system elegantly handles dual-funding. The advance deposit is utilized for non-admissible items first, and any remainder is refunded at discharge.