ORALZY
FAQ

TPA/insurance patient ka treatment ho gaya par approval pending — bill kaise rakhu?

Bill turant banao (record ke liye), payment pending rehne do — claim insurance/TPA module me file karo aur claim status wahan track karo. Patient se sirf co-pay/non-covered hissa lo.

Where in ORALZY: Practice → Insurance / TPA Claims

SITUATION

TPA patient ka treatment ho gaya, cashless approval abhi aayi nahi — counter confuse: bill banau? due dikhega to?

SAHI TAREEKA

  1. BILL TURANT banao — treatment hua hai to bill usi din ka hona chahiye (records, NABH, claim sab ke liye). Bill pe due dikhna is case me NORMAL hai — wo receivable TPA se aana hai, patient se nahi.
  2. CLAIM FILE karo — Insurance/TPA claims module me is bill ka claim banao, documents lagao. RGHS/TPA ke procedure-wise mandatory photos (claim-photo protocol, geo-stamped) pehle se le rakhe ho to yahi kaam aayenge.
  3. PATIENT SE kya lena hai: sirf co-pay ya non-covered items ka hissa — wo payment normally record karo. Baaki due claim settle hone tak khada rahega.
  4. SETTLEMENT aane par TPA ka paisa us bill me payment ki tarah record karo (mode: bank/NEFT, reference: UTR/claim no). Approved amount kam aya to difference ya to patient se lo (policy ke hisaab se) ya write-off karo.

DHYAN

Claim wale dues ko normal patient dues se alag samjho — Cash Flow Recovery me inko patient-dunning me mat daalo, TPA follow-up alag process hai.

PREVENTION

TPA cases me pre-authorization pehle lo aur scheme patient ke profile me set rakho.

Quick steps

  1. Treatment ke din hi bill bana do — due dikhna normal hai
  2. Insurance/TPA module me claim file karo, documents + claim photos lagao
  3. Patient se sirf co-pay/non-covered amount lo
  4. Settlement aane par TPA payment bill me record karo (UTR/claim ref ke saath)
  5. Short settlement ka difference policy ke hisaab se patient se lo ya write-off karo

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