Finance
Keep every TPA, corporate and government-scheme contract, rate card and claim in one place, tied to the same patient bill.
In short
Insurance and TPA management software stores each payer's contract and rate card and tracks claims from the bill to settlement. DevOrbital HMS brings contracts, rate cards and claims for TPAs, corporates and government schemes into one module connected to billing, with deferred payment support for Emergency and MLC cases.
The problem
TPAs, corporate tie-ups and government schemes each negotiate their own rates and exclusions, and billing staff end up working from PDFs and memory.
Without a single claims list, nobody can say quickly which claims are pending, queried or settled, and follow-ups are missed.
When the hospital bill and the claim document are prepared separately, mismatches show up at the TPA desk, which leads to queries and delays.
Discharge summaries, investigation reports and approvals sit with different departments, so assembling a claim file takes days.
How it works
Each TPA, corporate or scheme is recorded with its terms and rate card.
The patient's insurance or corporate details are attached to the admission or visit.
Charges are priced against the contracted rate card for that payer.
The claim is created from the same bill and supported by clinical documents.
Status is followed from submission through queries to settlement.
Settled and pending amounts feed reports for finance review.
What's included
Use it on its own — or connected
The Insurance and TPA module can run on its own for hospitals that mainly need contract and claim tracking. It works best with billing, because the claim is built from the same bill the patient sees. When IPD, diagnostics and MRD are also on DevOrbital, the clinical documents a TPA asks for are in the same patient record.
Pairs naturally with:
Machine integration
Who it's for
Illustrative scenario · not a customer story
Checking which claims need a follow-up
TPA desk coordinator
The coordinator starts her week by opening the claims list and filtering by payer. She sees several claims pending, and one is waiting for a document. She opens that claim, finds the bill already priced from the TPA's rate card, and attaches the missing report from the patient's record. Later, a corporate patient is discharged, and the bill picks up the corporate rate card automatically. At the end of the week, she shares the pending-by-payer view with the finance head. (Illustrative scenario.)
Insurance and TPA management software helps a hospital deal with third-party payers. In India, that usually means a TPA (third-party administrator) acting for an insurer, a company that has a tie-up for employee care, or a government scheme under which the hospital is empanelled. Each has its own rates, rules and paperwork.
The software records those arrangements, prices the patient's bill accordingly, and tracks the resulting claim until it is settled. DevOrbital's module keeps contracts, rate cards and claims together for TPAs, corporates and government schemes, and connects to billing so the claim and the bill come from one source. For a plain-language explainer, read TPA and insurance claim management for hospitals.
A rate card is the list of agreed prices for a payer. Without it in the system, billing staff apply standard tariffs by default or look up rates by hand, and either mistake can cause disputes. Under-charging loses revenue; over-charging produces queries and deductions at settlement.
With payer rate cards stored in the platform, the bill for an insured or corporate patient is priced against the right card from the start. When a contract is renegotiated, the new card is entered once and applied from then on, and the audit trail records the change.
This also helps with reporting. Finance can compare what was billed to each payer against what has been settled, rather than reconstructing it from several files at quarter end.
A claim is only as good as the bill and documents behind it. In DevOrbital, the claim is built from the final bill and kept alongside supporting documents such as discharge summaries and investigation reports. Because IPD and MRD hold those documents, the claims desk does not have to chase departments for copies.
Once a claim is submitted, the claims list shows its status so the team can follow up on those that are pending or have been queried. Settled amounts and outstanding dues feed finance reports, which turns a stack of individual claim files into a view of receivables by payer.
The exact stages and fields can be set up per hospital, since each payer's process differs slightly.
Emergency and medico-legal patients often arrive without clarity on payment or insurance. Treatment cannot wait, so the platform supports deferred payment: charges build up on the account and are settled later, either by the patient or, where applicable, by a payer.
Government-scheme patients bring their own rules, package rates and documentation. The module lets a hospital record those schemes as payers with their own rate cards and manage claims through the same list as TPA and corporate claims. That gives one place to see the full picture, which is the point of a connected finance workflow. To see how this fits the bigger goal, read how hospitals work to reduce billing leakage.
FAQ
A TPA, or third-party administrator, processes health insurance claims on behalf of an insurer. Hospitals empanelled with a TPA treat insured patients on a cashless basis or support reimbursement claims, and must bill at the rates agreed with that payer and submit documents for each claim.
Yes. The module manages contracts, rate cards and claims for TPAs, corporates and government schemes in one place. Each payer can have its own rate card, so billing applies the right tariff for the patient's coverage. The same claims list covers all payer types, so finance sees one picture.
The claim is prepared from the patient's bill in the billing module, so figures match between what the hospital charged and what it claims. Billing staff and claims staff work from the same record, which cuts down on re-entry and mismatches.
Yes. Deferred payment is supported for Emergency and MLC cases, so treatment is not held up by payment discussions. Charges accumulate on the account and remain visible as outstanding until they are settled. If a payer is identified later, the case can then be linked to that payer.
Yes. Rate cards can be updated when a contract is renegotiated, and the change is captured in the audit trail. New bills use the revised card, while earlier bills stay as they were when issued. Revision history helps when a payer queries an earlier bill.
The module is designed to prepare and track claims inside your hospital. Whether any particular payer portal or exchange can be connected is scoped separately during onboarding, because it depends on the payer's own systems. Many hospitals begin with internal tracking and add connections later.
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