TPA & Cashless Insurance Management
Manage insurance and TPA patients through a centralized digital workflow with Nilkanth Medico HOMS. From patient registration and insurance verification to pre-authorization, approval, treatment billing, claim documentation, discharge, settlement, and outstanding tracking, the system helps hospitals manage the complete cashless journey.
The module connects seamlessly with IPD, Billing, EMR/EHR, Pharmacy, Laboratory, Radiology, OT, Accounts, and Document Management for an interconnected hospital workflow.
- Insurance company
- TPA
- Policy number
- Member ID
- Card details
- Patient relationship
- Validity
- Corporate / company details
- Authorization information
- Claim-related details
- Insurance eligibility
- Policy information
- TPA details
- Coverage information
- Verification status
- Reference / authorization number
- Remarks
- Pending information
- Pre-authorization request
- Request date
- Requested amount
- Submitted documents
- Authorization status
- Approved amount
- Rejected amount
- TPA remarks
- Authorization number
- Insurance card
- Patient ID proof
- Doctor documents
- Investigation reports
- Clinical documents
- Treatment records
- Pre-authorization documents
- Approval letters
- Discharge documents
- Final bill
- Claim-related documents
- Initial approval
- Additional approval
- Enhancement request
- Approval date
- Pending queries
- Admission
- Ward
- Room
- Bed
- Treating doctor
- Diagnosis
- Treatment
- Procedures
- Investigations
- Pharmacy
- Discharge
- Insurance tariffs
- TPA tariffs
- Package rates
- Room charges
- Doctor charges
- Procedure charges
- Investigation charges
- Pharmacy charges
- Other hospital services
- Current bill amount
- Amount utilized
- Pending approval
- Additional charges
- Estimated final bill
- Initial approved amount
- Additional amount requested
- Supporting documents
- TPA response
- Revised approved amount
- Pending amount
- Claim number
- Submission date
- Claim amount
- Deduction
- Settlement amount
- Claim status
- Pending documents
- Hospital bill
- Submitted claim
- TPA deduction
- Insurance settlement
- Patient responsibility
- Non-payable items
- Policy exclusions
- Deductibles
- Co-payment
- Room-related differences
- Other configured patient responsibility
- TPA-wise outstanding
- Insurance company-wise outstanding
- Claim-wise outstanding
- Ageing
- Settlement status
- Follow-up remarks
- Insurance companies
- TPAs
- Corporate companies
- Tariffs
- Packages
- Policy-related configurations
- Approval categories
- Claim statuses
- User roles
- Permissions
- Department access
- Approval permissions
- Edit controls
- Audit trail
- User activity tracking
- TPA-Wise Patient List
- Insurance Company-Wise Patient List
- Cashless Admission Report
- Pre-Authorization Pending Report
- Approval Status Report
- Enhancement Request Report
- TPA-Wise Billing Report
- Insurance-Wise Billing Report
- Claim Submission Report
- Claim Pending Report
- Claim Rejection Report
- Claim Settlement Report
- TPA Outstanding Report
- Insurance Outstanding Report
- Ageing Analysis
- Deduction / Short Settlement Report
- Patient Payable Report
- TPA-Wise Revenue Report
- Insurance-Wise Revenue Report
Key Advantages & Capabilities of TPA & Cashless Insurance Management
Configurable TPA tariff sheets, interim bill tracking, and deduction management ensure faster claim approvals and minimal revenue write-offs for healthcare institutions.
Outstanding Tracking
Key Features 1. Insurance & TPA Patient Registration
Capture details such as:
Capture details such as:
2. Insurance Eligibility & Verification
Maintain the patient's insurance verification information before or during admission.
Frequently asked questions
TPA Management Software helps hospitals manage insurance and third-party administrator workflows including patient registration, authorization, approvals, billing, claims, settlement, and outstanding tracking.
Cashless Insurance Management enables hospitals to digitally manage eligible insurance patients whose treatment expenses are processed through the insurer or TPA according to applicable authorization and settlement procedures.
Yes. The system can record and track pre-authorization requests, requested amounts, documents, approval status, approved amounts, and TPA remarks.
Yes. Additional approval or enhancement requests can be tracked against the patient's admission and insurance case.
Yes. TPA and cashless billing workflows can be connected with IPD admission and hospital billing.
Yes. Claim submission, queries, resubmission, approval, rejection, settlement, and outstanding information can be tracked according to the configured workflow.
Yes. Hospitals can monitor TPA and insurance outstanding using claim-wise, company-wise, TPA-wise, and ageing-based reports.
Yes. Configured insurance, authorization, clinical, billing, and claim-related documents
Yes. Multiple insurance companies, TPAs, corporate accounts, tariffs, and related master data can be configured according to hospital requirements.
The system can use role-based access, permissions, audit trails, and user activity tracking to protect sensitive patient, insurance, and financial information.
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