STAGING COPY: for testing updates. Do not enter real patient data.
Claim file audit for hospital TPA desks

Find the gaps in a claim file before the insurer does.

Upload the scanned in-patient file. Ekline Claims sorts every page into its document group, checks it against your final file checklist and the payer's rules, and gives each desk a short list of what to fix, with page numbers. Then it tracks the claim until the money arrives.

A scanned file being sorted into document groups. Red and amber tabs mark pages with something to fix.

How a file goes through

Five steps, the same every time

  1. Upload the scan. The whole file as one PDF, in any page order, handwritten notes included.
  2. Pages are sorted. Discharge summary, nursing and ICP, investigations, bills, consents and ID, pre-auth and approval.
  3. Each desk gets its list. Doctors, nurses and billing see only their own items, marked Essential, Semi-essential or Non-essential.
  4. Fix and upload again. Only the items still open come back.
  5. Track to payment. Submission, queries, settlement, deductions, TDS and the payment received, claim by claim.

Set up for the documents asked for by PMJAY, Swasthya Sathi, WBHS, ECHS, ESIC and private insurers and TPAs.

Audit reportIP file 2611-0042 · Audit 1 · 109 pages
NOT READY4 Essential · 7 Semi · 2 Non
Treating doctor / RMO
Essential p.62 · Death summary time does not match ICP entry
Semi p.54 · ER note signed without registration stamp
Billing desk
Essential Bill p.1 · Pharmacy bills for 10/11 missing (₹6,433)
Semi Bill p.2 · Cabin days billed at ICU rate
ICU / Ward nursing
Essential p.71 · Vitals stop at 2 PM on day of death
The audit

A short list per desk, with page numbers.

No 40-page report to read. Doctors, nurses and billing see only their own items, each tagged by priority and the checklist line it breaks. Fix, re-upload, and only the open items come back.

Beyond the audit

The rest of the TPA desk

Your checklist, enforced

The audit follows your own final file checklist and each payer's document list. Add new rules as a skill file any time.

Letters to the TPA, drafted

Pre-auth, enhancement, query replies and claim cover letters written from the file, on your letterhead, sent from your mailbox.

Tracked to payment

Every claim from admission to settlement, with deductions, TDS and payment received, on one dashboard.

Ready when your TPA desk is

Send every claim file right the first time.

See Ekline Claims on a real, anonymised file from your own payer mix. We set up your hospital login on the same call.