TPA & cashless for a mid-size hospital
A mid-size hospital running significant cashless volume has a daily operational load: pre-auth to capture, documentation to keep consistent, and cases to track to settlement. Here is how Hayati supports the hospital side of that workflow — and the boundary of what software can and cannot do.
A mid-size hospital handling cashless (TPA) cases needs disciplined hospital-side workflow: capturing pre-authorisation, keeping bill components consistent, separating non-claimable items, and tracking each case to settlement — across OPD and IPD. Hayati organises that hospital-side documentation and workflow so cases are easier to manage. It does not approve, adjudicate, or settle claims; the TPA and insurer do that.
The situation. You run a hospital that is past the single-doctor stage but not a large enterprise chain — a nursing home or multispecialty hospital where a meaningful share of patients come through insurance. Cashless is a daily operational reality: pre-authorisation to raise and track, estimates and final bills to keep consistent, claimable and non-claimable items to separate, and a desk that needs to know at a glance what is pending versus approved.
This page is about running that at mid-size scale. The full intimation-to-settlement mechanism and the common reasons claims stall live on the TPA billing page; the Hospital OS identity is on Hospital OS. This is the operational story of a hospital living with cashless volume every day.
The hospital-side cashless workflow, at volume
The hospital side of a cashless case runs: intimation, admission and pre-authorisation, treatment-stage coordination, discharge, final bill, and tracking settlement status. At mid-size volume the challenge is doing this consistently across many concurrent cases without losing documentation or mixing up claimable components.
Hayati keeps each case's documentation attached to the visit and the bill: pre-auth letters and estimates stay with the case, claimable and non-claimable items are separated, and the desk gets a live view of pending versus approved amounts. That consistency is what makes a high cashless load manageable. The step-by-step workflow and rejection reasons are covered in depth on TPA billing — this page is about running it day to day at scale.
OPD, IPD, and departments on one record
Cashless doesn't happen in isolation — it sits on top of the hospital's normal operations:
- OPD and IPD on one visit record — consultations, investigations, admission, and the pharmacy all attach to the same case, so the final bill is complete and defensible.
- Doctor context — the doctor dashboard gives operational clinical context that connects to billing without re-keying.
- Scale across departments and branches — where you run multiple units, multi-branch governance keeps them consistent.
The boundary: what Hayati does and does not do
Hayati supports the hospital-side workflow and documentation for cashless cases. It does not approve claims, settle claims, act as the insurer or TPA, guarantee approval, guarantee faster settlement, or guarantee fewer rejections. Those outcomes are governed by each insurer and TPA, not by software.
This is the honest boundary, and it matters. Good software makes your hospital-side workflow disciplined and your documentation consistent — which is what you actually control. It cannot and does not promise a claims outcome. Any vendor implying software guarantees approvals, settlement speed, or a rejection rate is overclaiming. NABH and similar standards are referenced as context for how mid-size hospitals operate, not as a Hayati certification.
What to verify before you choose
- Does pre-auth documentation stay attached to the case? Ask to see a cashless case from intimation to final bill on a real screen.
- Are claimable and non-claimable items cleanly separated? This is where reconciliation usually breaks.
- Does OPD, IPD, and pharmacy roll into one defensible bill?
- Does billing keep working offline? A busy hospital desk cannot stall on a dropped connection.
Frequently asked questions
Hayati supports the hospital-side cashless workflow and documentation only; it does not approve, adjudicate, or settle claims, act as an insurer or TPA, or guarantee claim approval, settlement speed, or reduced rejections — those remain governed by each insurer and TPA. NABH and similar standards are referenced as context, not as Hayati certifications.