🧾 Healthcare ERP · Billing and insurance
Every service lands on the bill as it happens, packages and estimates stay in check, and cashless claims move through pre-authorisation, enhancement and discharge approval within the times IRDAI sets. Finance sees what each insurer, TPA and scheme owes, day by day.
Final bill₹2,43,600
Departments post charges straight to the patient's running bill, so nothing waits to be typed in at discharge. Work out what missed charges cost you below.
Captured automatically
A package is a fixed price for a procedure. Add extra days, ICU days or an implant upgrade and see what happens to the margin when extras are billed, or absorbed. Example: total knee replacement, one knee.
What you bill—
What it costs you—
Example costs and tariffs. Load your own tariffs and costs to see each package's real margin.
Change the room, the policy's room-rent limit, co-pay and sum insured. The split updates line by line, the way a TPA works it out. Example bill.
Under IRDAI's 2020 norms, proportionate deduction can't be applied to pharmacy, implants, medical devices, diagnostics or ICU charges.
Cut my claim deductionsEach step is timed against IRDAI's limits, and the desk sees which claims are close to breaching them.
Cashless pre-authorisation, enhancement and discharge approval within IRDAI timelines, through TPA portals or NHCX.
Package rates and pre-authorisation on the scheme's system, with ₹5 lakh a year per family and cover for everyone aged 70 and above.
Approved rate lists, referral letters and each scheme's claim format.
Credit limits, employee approvals and monthly statements for corporate patients.
Treatment is exempt from GST, but non-ICU rooms above ₹5,000 a day carry 5% GST, with no input tax credit for the hospital. Try a tariff.
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Exempt
Taxable
Rules in force since 18 July 2022. Confirm the treatment of your services with your tax adviser.
Outstanding amounts by payer and by age, and how much cash comes back when you collect faster. Example figures.
Outstanding by payer, example hospital
Total ₹5.40 Cr, of which ₹56 L (10.4%) is over 90 days old.
Days in A/R = outstanding receivables ÷ average revenue a day.
Cut my days in A/RNine capabilities, each linked to the related module or service.
Send us one month of bills and claims, and we'll show your missed charges, claim deductions and days in A/R in a live demo.
Get my billing reviewSee the Healthcare ERPSix steps to move your billing and insurance desks onto one system.
What changes once charges, claims and collections run on one system.
Charges post at source instead of being typed in at discharge.
The final bill is ready when the doctor signs off.
Documents and payer rules checked before a claim goes out.
Every rupee owed tracked by payer and by age.
From a single nursing home to a hospital group.
One integrated system.
Industries and services connected to hospital billing and insurance.
Answers for hospital owners, finance heads and insurance desks.
It turns every service a patient receives into a charge on their bill, handles OPD and IPD billing, packages, deposits and refunds, and manages cashless and reimbursement claims with insurers, TPAs and government schemes, so finance can see what is owed and by whom.
Under IRDAI's May 2024 master circular on health insurance, insurers must decide on a cashless request within one hour and give final authorisation for discharge within three hours of the hospital's request. If a delay beyond three hours adds charges, the insurer bears them.
If a patient stays in a room that costs more than the policy's room-rent limit, the insurer may reduce related expenses in the same proportion. Under IRDAI's 2020 norms it can't be applied to pharmacy, implants, medical devices, diagnostics or ICU charges, and it applies only where the hospital bills differently by room category.
Healthcare services by clinical establishments are exempt. Since 18 July 2022, non-ICU room rent above ₹5,000 a day per patient attracts 5% GST without input tax credit, and purely cosmetic procedures are taxable. The system applies these rules line by line; confirm the treatment with your tax adviser.
Yes. It handles package-based billing and pre-authorisation for AB PM-JAY, which gives ₹5 lakh a year per family and covers everyone aged 70 and above regardless of income, along with CGHS, ECHS and state scheme rates and claim formats.
The National Health Claims Exchange is the National Health Authority's platform for exchanging pre-authorisations and claims between hospitals, insurers and TPAs in a standard FHIR format. The system can send requests through NHCX as well as through insurer and TPA portals.
A package is a fixed price for a procedure that includes set items such as the stay, surgery and routine medicines. The system tracks what each package patient uses, bills exclusions such as extra days or implant upgrades where the package allows, and shows which packages lose money.
Yes. The desk creates an estimate from tariffs or packages, takes a deposit against it and keeps the patient updated as the bill grows, with alerts when the deposit runs low.
Usually 8 to 12 weeks, depending on tariffs, payer contracts and integrations such as TPA portals, NHCX, payment gateways and Tally. This is an estimate.
Tell us your bed count, monthly bills and the insurers and schemes you work with. We reply within 4 business hours and can demo with your own data.