TPA Management

Efficiently manage Third Party Administrators and insurance claims

About the TPA Management Module

The TPA Management Module in Mr.Doctor Hospital Management System allows hospitals to efficiently manage interactions with Third Party Administrators. It ensures accurate processing of insurance claims and timely settlements.

This module tracks approvals, claim statuses, and communication with TPAs, minimizing delays and errors, while providing full visibility to hospital administration for smooth operations.

TPA Management

Key Features

TPA Empanelment

Manage hospital empanelment and contracts with multiple TPAs.

Insurance Claims

Submit and track patient insurance claims efficiently with TPAs.

Reports & Analytics

View TPA performance, claim settlements, and pending approvals in real-time.

TPA Management Workflow

1. Patient Registration

Register patient with TPA details and insurance information

2. Pre-Authorization

Submit treatment plan to TPA for approval and authorization

3. Treatment & Documentation

Provide treatment and maintain detailed medical documentation

4. Claim Settlement

Submit final claim and track settlement from TPA

Advanced Features

Automated Claim Processing

AI-powered claim validation and automated submission to reduce processing time.

Real-time Notifications

Instant alerts for claim approvals, rejections, and settlement updates from TPAs.

Multi-TPA Integration

Seamlessly manage multiple TPA relationships and their different processes.

Analytics Dashboard

Comprehensive reports on claim success rates, settlement times, and TPA performance.

Compliance Management

Ensure adherence to TPA guidelines and regulatory requirements automatically.

Mobile Access

Access TPA information and claim status on mobile devices for quick updates.

Benefits

Faster claim processing and approvals
Reduced errors and discrepancies in claims
Streamlined communication with TPAs
Real-time visibility for hospital management
Improved cash flow and revenue cycle
Enhanced patient satisfaction with insurance coverage

Frequently Asked Questions

The system can manage unlimited TPAs simultaneously. Each TPA can have its own workflow, documentation requirements, and approval processes configured independently while maintaining centralized reporting and analytics.

When a claim is rejected, the system automatically notifies relevant staff with rejection reasons. It provides tools to address issues, resubmit corrected claims, and track the appeal process. Historical rejection data helps prevent future issues.

Yes, the system supports API integrations with major TPA portals for automated claim submission, status updates, and settlement notifications. This eliminates manual data entry and reduces processing time significantly.