TPA claims software for hospitals that are tired of chasing
For most Indian hospitals the largest single sum of money owed to them at any moment is sitting with TPAs, in claims at various stages, tracked in somebody’s spreadsheet. Uyirly runs the whole lifecycle on the same record as the admission — eligibility, pre-auth, enhancements, deductions, settlement and what is still outstanding.
- The full lifecycle: eligibility, pre-auth, enhancement, settlement, appeal
- Deductions recorded line by line, so you know what was disallowed and why
- Remittance batches reconciled against the claims they actually paid
- A live receivables figure instead of a spreadsheet nobody trusts
Why claims are different from billing
A cash bill is finished when it is paid. A claim is a months-long negotiation with an organisation that has every incentive to pay less and later. It gets raised, queried, partly approved, enhanced when the stay runs long, settled for an amount nobody predicted, with deductions that have to be argued or written off — and then the money arrives in a lump covering thirty claims at once and somebody has to work out which. Software that treats this as a bill with an insurer attached will not survive contact with a real TPA desk.
Before admission: is this patient actually covered?
The most expensive mistake in cashless is admitting a patient on the assumption of cover that turns out not to exist, and discovering it at discharge when the family is told to pay.
Policies and TPAs held properly
Insurers and TPAs are maintained as real records, with policies attached to patients — not a free-text field on an admission. Policy documents can be attached so the paper is where the claim is.
Eligibility decided and recorded
Eligibility is a step with an outcome — approved, rejected, or still pending — recorded against the encounter with who decided and when. An approved eligibility commits cover, and the rest of the hospital can then act on it: a cashless-approved patient is not held at the laboratory counter waiting for cash.
The claim, through its stages
Every claim moves through named stages rather than existing in somebody’s head, and the history of who moved it and when is kept.
- 1
Draft
Built against the encounter, with the bills it covers attached.
- 2
Awaiting eligibility
Cover being confirmed before the claim is raised.
- 3
Raised and submitted
Out with the TPA, with the claim and reference numbers recorded.
- 4
Approved or rejected
With the approved amount, which is rarely the claimed amount.
- 5
Settled
Money received, matched against what was approved.
The parts that spreadsheets lose
Everything above is the easy half. These four are where hospitals actually lose money, and they are the reason a spreadsheet stops working at about forty open claims.
Enhancements
A stay runs longer or a procedure escalates, and more cover has to be requested mid-admission. An enhancement is its own request with its own decision, attached to the claim, rather than a confusing second claim.
Deductions, itemised
TPAs disallow things. Recording the settlement as a single short figure tells you that you lost money but not why. Deductions are kept line by line, which is what lets you see a pattern across claims and argue the next one — or appeal this one.
Remittance reconciliation
Payment arrives as one transfer covering many claims. Uyirly holds remittance batches and lets settled claims be assigned to the batch that paid them, so a payment can be traced to the claims it discharged instead of being reconciled by hand against a bank statement.
Receivables you can believe
Because every stage and settlement is recorded, the amount outstanding with insurers is a figure the system knows rather than one somebody assembles on a Friday. You can see it per admission, or across the hospital.
The desk work around a claim
A claim is also a pile of paperwork and follow-up, and that part is usually what is really failing. Claims can be assigned to an owner so there is one named person responsible. A checklist per claim holds the documents the TPA wants, ticked as they are gathered. Documents attach to the claim itself. Notes build a running history of every phone call. Tariff packages hold the rates agreed with each insurer, and bank accounts record where settlements are expected to land. Rejected claims can be appealed as a tracked step rather than a resend and a hope.
Connected to the bill, not bolted beside it
The claim is built from the encounter’s actual bills, so what is claimed is what was charged. For an admitted patient that bill is accumulating daily rather than being assembled at discharge — see IPD billing — which is also what makes an enhancement request possible to justify mid-stay. The tax side of the same bill is covered under GST billing rules.
Frequently asked questions
Which plan includes insurance and TPA claims?
Growth and Enterprise.
Does it handle cashless as well as reimbursement?
Yes. Eligibility is confirmed and recorded before admission for cashless cases, and an approved eligibility lifts the payment gate elsewhere in the hospital so the patient is not held up at a counter.
Can we track enhancements for a long stay?
Yes. An enhancement is requested and decided as its own step attached to the claim, rather than being raised as a confusing second claim.
How are deductions handled?
Line by line, with the reason, rather than as one net settlement figure. That is what lets you see which items a given TPA routinely disallows and argue the next claim with evidence.
A TPA pays thirty claims in one transfer. Can we reconcile that?
Yes. Remittance batches are held as records and settled claims are assigned to the batch that paid them, so a bank credit can be traced to the specific claims it discharged.
Can we see what insurers owe us right now?
Yes — a receivables figure per admission and across the hospital, derived from the claim stages and settlements rather than maintained by hand.
Is Uyirly integrated with PMJAY or the NHA systems?
No. Claims are managed inside Uyirly and submitted to the TPA through your usual channel. There is no direct electronic integration with PMJAY or the National Health Authority, and we would rather say so than imply it.
See it in your own hospital
Uyirly runs OPD, IPD, pharmacy, lab, billing and staff scheduling in one platform. 30-day free trial, no credit card.
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