TPA Management

Improve hospital operational efficiency and financial stability through effective communication and collaboration tools for seamless interaction between hospitals and payers.
Generate detailed reports categorized by admission or claim type to facilitate efficient tracking and management of claims, optimizing the overall claim processes for operational efficiency.
Implement a streamlined system for prompt claim tracking and settlement, assigning unique claim numbers for easy reference to authorized details.
Provide timely notification to patients regarding service ineligibility, showcasing our commitment to transparency and superior customer service.
Ensure easy retrieval of essential documents to maintain a compliant audit trail.
Enhance the organization's document management capabilities to foster transparency and accountability.
Compile necessary documents, such as discharge summaries, investigation reports, pharmacy bills, OT implant invoices, to streamline document management processes.

Payer and Patient Management

Nirmalya HIMS's TPA acts as a crucial link between hospitals and payers, facilitating smooth communication and collaboration. It helps manage patient information accurately and securely, streamlining enrolment and ensuring error-free claims processing. The TPA's advanced features include party-wise rate management for simplified billing and improved accuracy. By tracking patients linked to specific payers and managing payer details meticulously, it enhances operational efficiency and financial health of healthcare facilities. Overall, Nirmalya HIMS's TPA serves as a reliable partner in promoting excellence and enhancing hospital operations.

Facilitate precise and secure handling of patient data to streamline enrollment and maintain thorough profiles for accurate claims processing.
Monitor patients linked to particular payers and organize payer information with rate management for simplified billing processes.
Enhance hospital operational efficiency and financial stability by utilizing professional functionalities for seamless communication and collaboration between hospitals and payers.

Planned or Emergency Claims

Nirmalya HIMS's TPA provides robust support for both planned and emergency claim processing, allowing for tailored claim processes. It enables smooth navigation through pre-authorization, admission treatment, and discharge for planned hospitalizations, as well as rapid admission pre-authorization, treatment, and timely discharge for emergencies. Detailed reports by admission or claim type enhance efficiency in tracking, managing, and settling claims. Leveraging Nirmalya HIMS's TPA functionality streamlines claim processes for seamless and accurate operations.

Enhance support for both planned and emergency claim processing, allowing for customization of the claim process to effectively meet specific requirements.
Streamline pre-authorization, admission treatment, and discharge procedures for planned hospitalizations to expedite pre-authorization, treatment, and discharge for emergency admissions.
Produce comprehensive reports organized by admission or claim type for efficient claim tracking and management, optimizing claim processes for smooth and precise operations.

Pre-Authorization

Nirmalya HIMS's Third Party Administrator (TPA) stands out for its seamless pre-authorization system, which covers a comprehensive range of steps from documentation to eligibility verification, policy coverage, deductibles, approved services, and limits. This meticulous process ensures quick and efficient tracking and settlement of claims. Once authorized, a unique claim number is promptly generated, allowing for smooth updates of pre-authorized information and documents to facilitate an error-free claim process. Furthermore, patients are promptly notified in case they are ineligible for specific services, showcasing a professional commitment to transparency and service excellence.

Initiate the pre-authorization process by confirming documentation, eligibility, insurance coverage, deductibles, approved services, and limitations.
Establish a streamlined system for tracking and settling claims promptly, assigning a distinct claim number for easy reference to pre-authorized details.
Notify patients promptly of any ineligibility for certain services, demonstrating our dedication to transparency and superior service.

Document Management

The Nirmalya HIMS's TPA system plays a vital role in streamlining the process of storing and retrieving crucial documents related to every TPA interaction and claim processing. By securely storing all necessary documents in a centralized system, it ensures easy retrieval whenever needed, ultimately facilitating an efficient audit trail in compliance with regulations. This meticulous approach not only enhances the organization's document management capabilities but also promotes transparency and accountability in handling TPA interactions and claim processing. The emphasis on maintaining a structured document repository reflects a commitment to operational excellence and regulatory adherence within the healthcare domain.

Facilitate the secure storage of documents pertaining to TPA interactions and claim processing in a centralized system.
Ensure ease of retrieval for necessary documents to maintain an efficient audit trail in accordance with regulations.
Improve the organization's document management capabilities, promoting transparency and accountability.

Claim Processing

Nirmalya HIMS’s Third Party Administrator (TPA) stands out as a comprehensive tool in the healthcare industry. It meticulously captures and organizes every step of the claims process, starting from submission up to adjudication. From rounding up imperative documents such as discharge summaries, investigation reports, pharmacy bills, OT implant invoices, to hospital invoices, the system seamlessly streamlines the claim processing workflow. Notably, it allows for amendments of any missing or inadequate details on claims that demand closer inspection, ensuring a meticulous audit trail for compliance purposes during adjudication. The TPA system exemplifies professionalism by providing a robust platform for accurate and efficient claims management.

Facilitate the capturing and organizing of all aspects of the claims process, from submission to adjudication, ensuring precise and effective claims management.
Collate necessary documents such as discharge summaries, investigation reports, pharmacy bills, OT implant invoices, and hospital invoices.
Simplify the workflow of claim processing and permit the correction of any missing or insufficient information to maintain a thorough audit trail for compliance during adjudication.

Payment Processing

Nirmalya HIMS's Third Party Administrator (TPA) is a sophisticated system that efficiently captures the payment method and intricate details from the payer's claim payment while also keeping track of any outstanding balance. Its robust features extend to documenting appeals by providing supplementary information that aids in reaching a final determination. This streamlined process not only ensures accurate and transparent management of claims but also offers easy access to claim status, accounts receivables, and account reconciliation. With Nirmalya HIMS's TPA, navigating through claims is seamless, reflecting a paramount commitment to precision and efficiency in healthcare administration.

Ensure clear and precise financial records by documenting payment methods and unpaid balances.
Supply essential details for appeals and enable comprehensive evaluation of claims to simplify tracking of claim status and managing accounts receivable.
Assist in smooth account reconciliation for a more efficient claims process, focusing on accuracy and transparency to enhance professional claim management practices.

Communication

Nirmalya HIMS’s Third-Party Administrator (TPA) embedded communication channels to enhance the overall process and streamline claim processing in a transparent manner. By integrating comprehensive data management into their system, Nirmalya HIMS ensures efficient communication with third parties, leading to expedited processes from pre-authorization to claim summation and final settlement seamlessly. This modern approach not only boosts efficiency but also fosters transparency throughout the entire claim processing journey, benefiting all parties involved in a professional manner.

Improve productivity and simplify the claim processing workflow by implementing transparent operational excellence throughout the claims lifecycle.
Implement a robust system for managing claim data to enhance communication and facilitate smooth transitions.
Ensure maximum operational efficiency and accuracy in the healthcare sector, from pre-authorization to claims aggregation to final settlement procedures.

Dashboard & Analytics

Nirmalya HIMS's TPA, integrated with Business Intelligence, provides a comprehensive solution that empowers efficient management and reporting of TPA interactions, claim status, and financial metrics. With robust reporting and dashboard capabilities, users gain valuable insights to make informed decisions. The tracking feature ensures that each stage of the claim process is monitored closely, enhancing transparency and accountability. By leveraging this technology, organizations can streamline operations and drive better outcomes, underlining the commitment to excellence and effectiveness in managing healthcare processes.

Produce payer management details including inpatient lists and claim reports organized by parties.
Produce reports on disallowed payments by payers, TDS ledger, lists of disputed bills, and aging reports.
Create lists of write-offs, live claim status, and track and identify commonly disallowed items.

Our implementation strategy is designed to ensure that your business operations undergo a swift and seamless transformation, resulting in faster time to value. Our experienced consultants utilize a structured approach that combines extensive industry knowledge with the latest implementation techniques. This enables you to expedite the deployment of our powerful solution and experience a rapid return on investment.

Through our streamlined process, you can optimize productivity and streamline business processes with minimal disruption. We have consolidated the expertise gained from global deployments into a set of leading practices, providing a clear path to success and delivering rapid business value.

With Nirmalya, you can confidently expect to go live within a predictable timeframe through smart, stepped implementations.

Nirmalya offers its services to companies of all sizes, including startups, fast-growing businesses, medium-sized enterprises, large corporations, and non-profit organizations. We assist these companies in streamlining their operational capabilities without the need for significant capital and operational expenditures. By eliminating the burden of maintaining an Enterprise Resource Planning system, which typically involves investments in manpower, hardware, and software, we help companies focus on their core activities.

Our collaboration with companies involves an initial setup fee for implementation, followed by an annual license fee based on the modules chosen by the customer for implementation. As businesses expand, customers have the flexibility to incorporate new modules as needed.

TPA Management

Transparent Communication

Compliance Management

Process Optimization

Nurture, Collaborate, and Grow

Experience a multitude of benefits that awaits

Prominent attributes to enhance your organization

Payer and Patient Management

Planned or Emergency Claims

Pre-Authorization

Document Management

Claim Processing

Payment Processing

Communication

Dashboard & Analytics

Resolving a wide range of challenges

Transparency and Accuracy

Claim Evaluation

Account Reconciliation

Transparent Communication

Compliance Management

Process Optimization

Accelerated Value Realization

How much does it cost?

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