Claim files, queries, checklists and getting paid in full, from the team behind Ekline Claims.
The documents insurers and TPAs ask for most often, grouped by the desk that owns them, so nothing is missing when the file is sent.
From the patient at the admission counter to the money in the hospital account: the eight steps of a cashless claim, and where each one goes wrong.
The 2024 master circular gives insurers tight time limits. Hospitals only benefit if their own requests are complete the first time.
Knowing where each claim stands, and what was deducted, is how a hospital gets paid in full.
Most denials and deductions trace back to a handful of avoidable gaps in the file. Here they are, with what the desk can do about each.
Third party administrators process a large share of India's cashless claims. Here is what they do, and how to make every file easy for them to approve.
Gloves, masks, admission kits and other consumables are often deducted. Here is how hospitals can bill them in a way that holds up.
A good checklist is short, ordered the way the file is assembled, and says who owns each line.
A good query reply answers exactly what was asked, attaches exactly what was asked for, and goes out the same day.
An enhancement sent late turns into a deduction at discharge. Send it as soon as the plan or the stay changes.
The discharge summary is the first page a claim reviewer reads. These are the fields it must have, and the mistakes that cause queries.
Most TPA queries come from a short list of gaps that can be caught before the file leaves the hospital.
Revenue cycle management for Indian hospitals comes down to three things: clean files, fast replies and tight follow-up.
Government scheme claims follow package rates and strict documentation. A short, repeatable checklist keeps them moving.
AI is good at reading a hundred scanned pages and finding what is missing. Here is what it can and cannot do for a claims desk.
See Ekline Claims on a real, anonymised file from your own payer mix. We set up your hospital login on the same call.
