Problems faced by hospitals in getting timely claim payments from TPAs and Health Insurers

In today’s world of Payer getting increasingly powerful like Government insurer making the process stricter is leading to hospital having outstanding payments with Government and private insurers and TPAs for the services provided. Hospitals need to put in place a dedicated TPA desk and processes and systems including using a robust billing and EMR system to avoid those delays or denials of their payments by TPAs. Over the past few years, the popularity of cashless health insurance has shot up several notches with obvious reasons. The major advantage of this is to ease the burden of financial losses that need to be incurred at the time of any unforeseen accident. Cashless insurance service calls for a hassle-free process in which you have to not be tensed of cash in case of any emergency. However, few challenges have to be faced while dealing with cashless health insurance claims.

Document completion during submission

This is a common problem, if the hospital has not trained the staff to provide the proper case files including the signatures of treating physicians. Having a standard EMR system can also help solve this problem as there could be a checklist of documents at the time of discharge.

Uneven charges for treatment

The charges for treatment or a service are not standard and varies for Insurers based on their agreement. Hospital billing system should be able to cater to this in an easy manner.

Standardization of claim forms

Every company has their own claim forms. The clerk at the hospital might get confused. Standardized forms can eliminate this pain point with help from autofill feature from a Hospital EMR and Billing software.

Transparency in deductions

While making the claims, the company deducts many charges, which the patient is unknown of. The Non-transparency in these deduction can causes problems with hospital and patient so there should be transparency in expelling the charges and what is included in any package and what’s not.


The TPA companies timely removes and adds hospital to their networks. If the policy holders are not informed by the TPA about these changes, this can be a pain point for the patient for claiming. Another issue that quite a few customers face during the claim of cashless insurance is a rejection of their cases in the lack of adequate information. Though services differ from TPA to TPA, but customers are generally at the receiving end, we just need to follow steps prescribed to get it. So, it is better to have information beforehand like knowing list of the hospitals under cashless service, read the terms and conditions properly, inform the TPA as soon as possible and always be ready with documentations.

Apart from that modern HIS and cloud systems help hospitals in tracking queries raised and documents pending. Also, through analysis one can avoid repeat errors in submissions by training the staff on common errors.

DocEzzy is a modern technology HIS platform with TPA module, which helps Hospitals and doctors to achieve their TPA processes seamless.


Kindly visit for further details or call us on 9619935643/9833420206 for a free demo.

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