A cashless claim is settled directly between hospital and payer. A reimbursement claim is paid by the patient and claimed back afterwards. Admissions convert from the first to the second most often through missed notification windows, incomplete pre-authorisation, or non-network status discovered after admission.
The three conversion causes
Missed notification — commonly 24 hours emergency, 72 hours planned. The clock starts at admission, not when the TPA desk opens.
Incomplete pre-authorisation, where a submission went inside the window but without a mandatory field, so it was never actually accepted.
Network status assumed rather than checked, which surfaces at approval rather than admission.
Why it matters more than rejection
A rejected claim is a known loss. A converted claim is a collection problem and a reputational one: the family was told cashless and is now paying at discharge.
The money usually arrives. The relationship often does not.
What to put a number on.
Time from admission to notification, per payer, with the window as the threshold. And the count of conversions per month, which most hospitals do not track as a category at all.
Questions we get asked
How long do I have to notify a cashless admission?
Commonly 24 hours for emergency and 72 hours for planned admissions, but the window is contract-specific and should be tracked per payer.
Does a converted claim still get paid?
Usually yes, but by the patient at discharge, who then claims it back themselves over subsequent months.
Built to international standards. Sold in India only, for now.
Drapto is engineered the way any serious international health platform is — FHIR R4, audit trails, Indian data residency — and sold exclusively to Indian clinics and hospitals, so the payer mechanics, scheme rates and clinical vocabulary are modelled rather than approximated.