TPA & Insurance Billing Software for Hospitals
Cashless patients need different rates, co-payments and paperwork. NexoraHMS keeps TPA partners, their credit limits and rate cards inside the billing system, so the insured bill is right the first time.
Works offlineCGHS rate masterTPA, ECHS & PM-JAYOne-time licenceEnglish + Hindi
Insurance billing goes wrong when the billing desk does not know the TPA's agreed rates or the patient's co-payment, and the difference is found only when the claim is short-paid.
In NexoraHMS each TPA is a partner with its own rate card, discount and credit limit. The patient's sponsor is set at admission, co-payment is collected upfront and the claim can be tracked against the final bill.
TPA Billing Features
TPA rules sit in the system, not in a file at the billing counter.
- TPA partners with credit limits, discounts and quick rate card
- Sponsor-wise service rates for TPAs and corporate panels
- Co-payment collection at admission
- Packages for surgical and scheme cases
- Claim tracking against the final IPD bill
- Outstanding report for insurer and TPA balances
TPA & Insurance Billing in Four Steps
Add TPA partners
Record each TPA with its rate card, discount and credit limit.
Mark the sponsor
Set the TPA at admission and collect the patient's co-payment.
Bill at agreed rates
Services post at the TPA rate; the patient share is shown separately.
Track the claim
Follow the claim and balance until the insurer settles.
Settlement and Follow-up
- Patient share and sponsor share visible on settlement
- Refunds and adjustments recorded with the user
- Discharge summary ready for claim documents
- Sponsor-wise outstanding in collection reports
Who Uses NexoraHMS TPA & Insurance Billing
Hospitals with many TPA tie-ups
Different rate cards applied without lookup sheets.
Nursing homes starting cashless
A simple way to manage a few TPAs correctly.
Surgical centres
Package rates and co-payments for planned procedures.
NexoraSoft installs NexoraHMS on site across Delhi NCR from our Kirti Nagar, New Delhi office, sets up masters, migrates data and trains staff. Hospitals elsewhere in India are set up remotely.
TPA & Insurance Billing: FAQ
Yes. Each TPA partner has a rate card and discount, and sponsor-wise service rates apply on the bill.
Yes. Co-payment can be collected at admission and shown separately on the bill.
Yes. Credit limits are stored on the TPA partner record.
NexoraHMS prepares the bill, discharge summary and claim tracking inside the hospital. Submission is done on the TPA or insurer portal by your claims team.
PM-JAY uses package billing. See our PM-JAY software page for details.
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