ORALZY
FAQ

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

Bill turant banao (record ke liye), due khada rehne do — claim Billing → Insurance & RGHS → Insurance → '+ New Claim' se banao aur status wahan track karo. Patient se sirf co-pay / non-covered hissa lo; TPA ka paisa aane par usi bill par payment darj karo (claim 'Settle' karne se bill apne aap paid nahi hota).

Where in ORALZY: Billing → Insurance & RGHS → Insurance → 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. Billing → Insurance & RGHS → Insurance → '+ New Claim' se claim banao (company + amount); X-ray / documents TPA ko alag se bhejo — claim me attach ka option nahi
  3. Patient se sirf co-pay / non-covered amount lo
  4. TPA ka faisla aane par claim 'Settle' karo aur TPA ka paisa bill par payment ki tarah darj karo
  5. Kam paisa aaya to difference policy ke hisaab se patient se lo ya write-off karo

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