TPA & Claims

TPA claims tracked from submission to settlement.

Every insurance claim — pre-authorisation request, document submission, approval, rejection, resubmission, and final settlement — tracked in one screen. Average TPA settlement time drops from 60 days to 18 days at hospitals using ZenoHosp.

  • Pre-authorisation requests sent and tracked from the admission screen
  • Claim documents compiled automatically from patient record
  • Rejected claims flagged with reason code for resubmission
  • Settlement status per claim — submitted, approved, settled, outstanding
  • TPA-wise collection dashboard — who owes what
TPA Claims Tracker DashboardAdd app screenshot here

Pre-Auth Tracking

Request sent, approval status tracked from admission.

Claim Status

Every claim tracked end-to-end.

Rejection Alerts

Rejected claims flagged with reason codes.

Settlement Analytics

Days outstanding per TPA — trends and benchmarks.

Pre-auth request sent at admission — not scrambled at discharge.

When a TPA patient is admitted, ZenoHosp generates the pre-authorisation request from the patient's admission details and insurance information. The request is sent to the TPA, and the approval status is tracked from within ZenoHosp. The billing team sees the approved amount before discharge.

  • Pre-auth request generated from admission details automatically
  • Approval status tracked — approved amount visible to billing team
  • Enhancement requests for additional procedures sent from the same screen
  • Pre-auth approval stored against patient record for discharge bill
Pre-Authorisation Request ViewAdd app screenshot here

Every claim filed. Every status tracked. Nothing lost.

After discharge, ZenoHosp compiles the claim package — discharge summary, itemised bill, investigation reports, consent forms — from the patient's record. The claim is submitted to the TPA and tracked through every stage.

  • Claim documents compiled automatically from the patient record
  • Missing documents flagged before submission — prevents rejection
  • Claim status: Submitted, Under Review, Approved, Rejected, Settled
  • Days outstanding per claim tracked — escalation at 30 days
Claim Submission & Status ViewAdd app screenshot here

Rejected claims corrected and resubmitted — faster.

When a TPA rejects a claim, ZenoHosp flags it with the rejection reason code. The billing team sees exactly what needs to be corrected, updates the documentation, and resubmits — from the same screen. Resubmission is tracked as a separate stage.

  • Rejection reason code displayed alongside rejected claim
  • Document correction and resubmission from the same screen
  • Resubmission tracked separately from original submission
  • Rejection analysis — top reasons identified for process improvement
Claim Rejection & Resubmission ViewAdd app screenshot here
18 days
Average TPA settlement (was 60 days)
0
Claims lost or forgotten with end-to-end tracking
40%
Reduction in claim rejection rate after document pre-check
"Our TPA team used to manage claims in a spreadsheet. Claims got lost. Settlements were delayed 60–90 days. Since ZenoHosp, everything is tracked. Our average settlement is now 18 days."
Billing Manager, 350-bed hospital, Chennai

Everything included

Every capability — built for Indian hospital workflows.

Pre-authorisation managementRequest sent and approval tracked at admission.
Enhancement requestsAdditional procedure approvals sent from the same screen.
Claim document compilationAutomatically assembled from the patient record.
Missing document alertsFlagged before submission to prevent rejection.
Claim status trackingSubmitted → Under Review → Approved → Settled.
Days outstanding trackingEscalation alerts when claims exceed target days.
Rejection reason displayReason code shown for every rejected claim.
Resubmission workflowCorrected and resubmitted from within ZenoHosp.
TPA-wise collection dashboardOutstanding amounts per insurer — aged by days.
Settlement reconciliationReceived amount matched against approved amount.
IRDAI-compliant documentationClaim formats aligned with IRDAI requirements.
40+ TPA integrationsStar Health, ICICI, Medi Assist, United Health, and more.

Frequently asked questions

How does ZenoHosp send pre-authorisation requests?

When a TPA patient is admitted, ZenoHosp generates the pre-authorisation request from admission details and insurance information. The request is sent to the TPA and the approval status is tracked within ZenoHosp.

What happens when a TPA rejects a claim?

Rejected claims are flagged with the rejection reason code. The billing team sees exactly what needs correction, updates documentation, and resubmits from the same screen. Resubmission is tracked as a separate stage.

How does ZenoHosp track claim documents to prevent rejection?

Before a claim is submitted, ZenoHosp checks that all required documents are present — discharge summary, itemised bill, investigation reports, consent forms. Missing documents are flagged before submission.

See it in action.

45-minute demo. Your hospital type, your workflows.

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