WebSoftOSHow it works
Claims are queried or rejected mostly for missing pre-authorisation, a diagnosis that does not match the bill, the wrong package rate, missing documents or late submission. Each delayed claim adds to the hospital’s receivables.
Tracking each claim with its documents and a follow-up date is the main discipline.
Example
If 15% of 100 claims averaging ₹60,000 are delayed, about ₹9 lakh of receivables is stuck (assumed figures).
Frequently asked questions
Is a TPA the same as an insurer?
No. The insurer carries the risk. The TPA administers claims for the insurer, though some insurers process claims in-house.