Faster Cashless Approvals and Cleaner Claim Settlement
Care18 connects the insurance desk, billing counter and clinical teams around a single claim record. Pre-authorisation requests, document checks, claim submissions and settlement follow-ups move through one workflow, so the team spends less time chasing files and more time resolving patient queries.
- Cashless and reimbursement in one desk
- Pre-authorisation with recorded responses
- Checklist-driven claim submissions
- Settlement tracked to the last query
What Is Insurance & TPA Management in Care18?
The insurance and TPA desk sits between the patient, the hospital and the payer, and most of its pain is document handling. Care18 replaces paper claim files, telephonic follow-ups and spreadsheet trackers with one structured process. Eligibility, pre-authorisation, discharge documents, final bills and settlement responses all stay attached to the patient's claim file, keeping billing staff, ward teams and the TPA desk on the same page.
- Eligibility and policy capture at admission
- Pre-authorisation requests with recorded TPA responses
- Checklist-driven claim document packets
- Live claim status visible across teams
- Settlement matched back to billing records
Key Benefits
Faster Cashless Approvals
Pre-authorisation requests reach the TPA desk with complete documents and clear status, reducing delays for patients waiting to begin treatment.
Fewer Claim Rejections
Document checklists and eligibility verification happen before submission, so claims are not returned for missing paperwork or mismatched policy details.
Transparent Claim Tracking
Every claim carries a visible status and history, so staff can answer patient and TPA queries without searching through files or call logs.
Quicker Settlement Reconciliation
Paid, partially paid and rejected amounts are recorded against each claim, giving finance a clean view of pending and settled dues.
Key Features
Eligibility & Policy Capture
Record policy number, insurer, plan type and validity at admission, so the insurance desk works from verified details rather than photocopies.
Pre-Authorisation Workflow
Raise pre-authorisation requests with treatment plans and estimated costs, track TPA responses and record approvals against the patient's admission record.
Claim Document Packets
Assemble bills, reports, prescriptions and discharge documents into a checklist-driven packet that is complete before the claim leaves the hospital.
Claim Status Tracking
Follow each claim through submitted, under query, approved and settled stages, with notes and follow-up dates visible to the whole desk.
Settlement & Reconciliation
Match insurer payments and deductions against raised claims, flag short payments and route recoverable amounts back to billing for correction.
Rejection & Query Handling
Record query reasons, attach supplementary documents and resubmit from the same file, keeping a full trail of every revision and response.
Insurance & TPA Workflow in Care18
From eligibility check to final settlement, every claim follows a documented path.
- 01
Eligibility Check
Insurance details are captured at admission and eligibility confirmed with the insurer before treatment begins, along with any plan restrictions.
- 02
Pre-Authorisation
The desk submits the pre-authorisation request with clinical notes and estimated costs, then records the insurer's decision and approval reference.
- 03
Treatment & Document Capture
Bills, investigation reports, prescriptions and discharge summaries are collected against the claim as care progresses through the stay.
- 04
Claim Submission
The completed document packet is reviewed against the checklist and submitted to the TPA with a recorded submission date.
- 05
Settlement & Follow-up
Responses, queries and payments are logged against the claim until final settlement is recorded and reconciled with billing.
Security Built Into Every Layer
Hospital data deserves enterprise-grade protection. Care18 is designed with security at its core — access control, encryption, auditability and recoverability.
Role-Based Access Control
Every user sees only what their role permits, down to the field and report.
Encrypted Data
Encryption in transit and at rest for records, attachments and backups.
Audit Trails
Immutable, timestamped logs of who changed what, when and from where.
Secure Authentication
Password policy, multi-factor options and session control for sensitive actions.
Cloud Backups
Automated, encrypted backup schedules with retention policies you control.
Disaster Recovery
Documented recovery procedures, standby infrastructure and restore testing.
Who Benefits
Cashless Admissions
Manages pre-authorisation and approval tracking for patients admitted under cashless arrangements, keeping ward and billing teams informed.
Reimbursement Claims
Supports post-discharge reimbursement files where documents are compiled and submitted after the patient settles the bill.
Corporate & Group Policies
Handles employee and group policy claims with insurer-specific document requirements tracked per case, with follow-ups scheduled until the claim closes.
Multi-Insurer Management
Keeps separate workflows, contacts and query history for each insurer and TPA without mixing files.
Related Modules
Explore other modules that work seamlessly with this solution
Frequently Asked Questions
Turn Claim Chaos into a Clear Process
Book a free demo to see how Care18 handles eligibility, pre-authorisation, claim tracking and settlement for your insurance desk.