TPA & Insurance Management Software for Faster Cashless Approvals & Claim Settlements

Insurance and TPA workflows are complex, time-sensitive, and documentation-heavy. SWI Hospital Management Software digitizes the complete insurance lifecycle from pre-authorization to final settlement.

Reduce claim delays, avoid rejections, and improve cash flow with a fully integrated TPA & Insurance module.

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TPA and insurance management software dashboard showing cashless approval overview, pre authorization tracking, pending claims, insurance billing, claim settlements, denial management and TPA reports for hospitals

Why TPA & Insurance Digitization Is Critical

Manual insurance handling leads to delayed approvals, missing documents, claim rejections, and revenue blockage.

A digital TPA & Insurance Management System ensures structured workflows, complete documentation, and faster claim turnaround.

Insurance Company & TPA Master Management

Maintain centralized master records for all insurance companies and TPAs.

Master Setup Features

Insurance company & TPA master creation
Policy types and coverage rules
Tariff and rate mapping
Validity and contract tracking
Empanelment status & network hospital tracking
Department-wise and procedure-wise rate configuration
Room rent capping and sub-limit rule setup
Excluded services and non-payable item mapping
Pre-auth and claim document checklist configuration
Contract renewal alerts and expiry notifications

Insurance company and TPA master management module for hospital claim processing and empanelment setup

Pre-Authorization Request & Approval Tracking

Pre-auth request creation
Medical documents & estimates upload
Approval, query & rejection tracking
Auto alerts for pending approvals
Pre-auth initiation from IPD admission and doctor orders
Auto estimate generation for package and non-package cases
Room capping and sub-limit validation alerts
Query response workflow with resubmission tracking
Approval letter storage with billing auto-link
TAT reports, pending dashboard and escalation alerts

Insurance Pre Authorization Management Software

IPD Billing & Insurance Linkage

Ensure accurate billing aligned with insurance rules and approved limits.

Package and non-package billing
Auto segregation of insurer & patient share
Real-time utilization vs approval tracking
Excess and co-pay calculation

Claim Submission & Settlement Tracking

Digitize post-discharge insurance workflows to speed up claim settlements.

Claim document checklist
Submission date & TAT tracking
Settlement amount reconciliation
Shortfall and deduction tracking

Integrated TPA & Insurance Workflow

Insurance module is tightly integrated with OPD, IPD, EMR, OT, billing, pharmacy, diagnostics, and payments.

This ensures zero duplication and complete claim traceability.

Admission → Pre-Auth → Treatment
Billing → Claim → Settlement
Insurance + patient financial clarity
Single insurance patient record

Insurance company-wise claims
TPA-wise approval & rejection analysis
Pending claims ageing
Settlement vs billed amount reports

Insurance & TPA Reports & Analytics

Gain visibility into insurance performance, cash flow, and claim efficiency with real-time analytics dashboards.

Security, Compliance & Audit Readiness

Insurance workflows must meet regulatory, audit, and data security standards.

SWI HMS ensures secure access, documentation traceability, and NABH-aligned insurance processes.

Role-based insurance access
Time-stamped insurance actions
Complete audit trails
NABH-ready insurance documentation

Why Choose SWI for TPA & Insurance Management?

Faster Approvals · Fewer Rejections · Better Cash Flow · NABH-Ready

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