TPA and Insurance Management

The latest challenge for any hospital is to manage Third Party Administration (TPA) and cashless Insurance Management. In Electra HMIS we have taken care of all this and offer to integrate the insurance companies billing module with ours in order to process the settlement of the bills of a patient insured or covered. It helps in verifying the eligibility of a patient for reimbursement purposes and saves all stake holders from many hassles. This in fact works in real time but online on behalf of the patient in a prescribed or a particular format, which includes the discharge summary and various consumption bills of the patients. Tracking the status of the claims becomes easy with the help of our system. Summary of features is given below.

Features of the TPA and Insurance Module

  • Provision to record the TPA and Insurance details of a patient.
  • Instant verification of eligibility of the patient.
  • Online submission of claims forms.
  • Provision for follow up with the TPA's and Insurance companies.
  • Status enquiry of the submitted claims.
  • Integration with other modules for discharge summary and other details.
  • Provision to bill the patient separately for the services provided by the hospital that are not covered by the TPA and Insurance companies.
  • Provision for cashless hospitalization.