Claims and revenue integrity
Risk scoring, room caps, the pre-auth clock and queries.
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✓ written for 11pm, not the demo
How a claim is scoredTwenty-four rules, what they look at, and why the queue is sorted by exposure.Room rent caps and proportionate deductionThe single largest preventable deduction in Indian hospital billing, and where to stop it.Raising a query on a short-paymentThe window, what to attach, and what “as per policy terms” actually means.Documentation deficienciesThe hospital-side causes, in the order they cost money.
Other sections
Getting startedSetting up a clinic or hospital, users, roles and the first week.AppointmentsThe book, the waitlist, cancellations, no-shows and family bookings.Patients and recordsOne record per person, merging duplicates, UHIDs and consent.PrescriptionsTyped prescriptions, interactions, and what the patient receives.LabsOrders, samples, abnormal flagging and how a result is released.PharmacyDispensing, one shared drug list, stock, expiry and substitutions.Billing and collectionsBills, patient balances, ageing and what a write-off means here.Pre-authorisationRaising it, the clock, enhancements and what stops an approval.
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