For hospital insurance desks
We work with your insurance desk on every cashless claim, from pre-authorisation to the bank credit. The claim data comes out in NHCX format along the way.
The same twelve example claims, at two desks
Gaps surface after the claim is sent, as queries and cuts. The patient learns their share at discharge.
Gaps are fixed at our check, inside the hospital. The patient’s share is told at admission. Cuts are disputed; not every dispute is won.
An illustration of the method with example claims, not a measured result.
In 2023–24, India’s health insurers paid 71% of the ₹1.17 lakh crore claimed. They disallowed ₹15,100 crore and repudiated ₹10,937 crore.
IRDAI Annual Report 2023–24, as reported by PTI. These are industry-wide figures. They include valid rejections and amounts patients owe under their policies. What your hospital loses is what our audit measures.
The insurer must decide within one hour.
Where it leaksRequests go in thin. They are approved short or denied, and enhancements are raised late.
What we doWe build each request from the clinical notes, with the evidence a reviewer looks for, and our clinical team checks it.
Final approval is due within three hours.
Where it leaksA missing report, a wrong code, a non-payable item, a charge above the agreed tariff.
What we doWe audit the bill and the file against the policy, the tariff and IRDAI’s lists before anything is sent.
While a query waits, the patient waits.
Where it leaksReplies go late or incomplete, and an unanswered query turns into a cut.
What we doA draft reply is assembled from the medical record in minutes. A doctor approves it before it goes.
The money arrives later, often short.
Where it leaksNo one matches the payment to the bill. Short payments are written off.
What we doWe match every payment to its bank credit, mark each cut as the policy’s or the hospital’s, and dispute the wrong ones.
By-productEvery step produces FHIR R4 claim data, so your claims are ready for NHCX.
Across every claim, reports by insurer and TPA show what each one cuts and why. That is the evidence for your next tariff negotiation.
An example final bill, read the way an insurer’s reviewer reads it, then the way we read it before it is sent. Blue is the policy’s share, which the patient owes. Black is the hospital’s loss, which is preventable.
Final bill Example
₹6,000 cut. The room is above the ₹4,000-a-day limit. Limit explained at admission, in writing. The patient chose the room knowing the cost.
Linked charges paid at two-thirds, in proportion to the room. ₹25,500 cut. Same cut, on the patient’s estimate from admission.
Held. Query raised: implant invoice and barcode sticker missing. Invoice and barcode sticker attached before sending.
₹2,400 cut. Two items with no matching entry in the medication chart sent. Medication chart pages added to the file. Payable in full.
₹1,800 cut. Billed above the agreed tariff. Rebilled at the agreed tariff. A smaller bill, and no query.
Not payable under IRDAI’s lists of non-medical items. On the patient’s estimate from admission.
Example bill. The amounts are illustrative, not from a real patient or hospital.
The National Health Claims Exchange, run by the National Health Authority, carries claims as FHIR R4 bundles defined in the ABDM implementation guide published by NRCeS. Every claim we prepare is structured that way from the first step.
When your insurers move to the exchange, your claims are already in its format. There is no second project.
Where we are, October 2026
We study a sample of your recent cashless claims on site, under a mutual NDA. No patient-identifiable data leaves the premises.
Where you lose money, by stage and by insurer, and which losses are the policy’s and which are yours. The report is yours to keep.
Under a separate written proposal, which states any price.
What the report measures
From your own claims. We publish no figure we have not measured.
Not as of October 2026. The exchange is live and insurers are connecting to it. When yours move, the claims we prepare are already in its format.
No. We work on top of the system and documents you already have.
No. Your desk keeps its people and its relationships with insurers and TPAs. We take the repetitive work and the follow-up off it.
Not during the audit. No patient-identifiable data leaves the premises, and the work runs under a mutual NDA. Data handling for any later work is set out in its proposal.
Nothing. Any work after it is priced in a written proposal.
