Discharge Settlement
Every final bill checked against the pre-auth and tariff, so final authorisation lands well inside 3 hours.
Why it matters
At discharge the final bill, summary and reports are checked line by line by hand; patients wait in the room and late approvals cost the insurer.
How the solution handles it
Agents read the discharge pack, reconcile it to the approved pre-auth, check every line against tariff, packages and policy limits, find non-payable items and explain each deduction. A medical officer gives final approval.
How a discharge moves
Five agents read, reconcile, price and explain every line of the final bill; a medical officer gives final approval.
What it reads, and what it hands back.
What goes in
- Final hospital bill
- Discharge summary
- Investigation reports
- Approved pre-auth
- Hospital tariff
What comes out
- Final authorisation ready to sign
- Deduction sheet with reasons
- Enhancement note
- Clock on every discharge
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
Source: IRDAI Master Circular on Health Insurance Business (May 2024), final authorisation within 3 hours · “Target” = design goal, measured in the live solution · agents = the live solution’s configuration
5 specialist agents. One person decides.
More in this division.
Every cashless request checked against policy and tariff, ready for a doctor well inside the 1-hour clock.
Reimbursement ClaimsEvery reimbursement claim read, checked and priced, with a cited file ready for decision in a day.
Bill & Tariff AuditEvery hospital bill audited line by line against agreed tariffs and packages, every deduction cited.
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