TPA & Insurance Management Software for Faster Cashless Approvals & Claim Settlements

Insurance and TPA workflows are complex, time-sensitive, and documentation-heavy. SWI Hospital Management Software digitizes the complete insurance lifecycle from pre-authorization to final settlement.

Reduce claim delays, avoid rejections, and improve cash flow with a fully integrated TPA & Insurance module.

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TPA and Insurance Management Software Dashboard

Why TPA & Insurance Digitization Is Critical

Manual insurance handling leads to delayed approvals, missing documents, claim rejections, and revenue blockage.

A digital TPA & Insurance Management System ensures structured workflows, complete documentation, and faster claim turnaround.

Insurance Company & TPA Master Management

Maintain centralized master records for all insurance companies and TPAs.

Master Setup Features

  • Insurance company & TPA master creation
  • Policy types and coverage rules
  • Tariff and rate mapping
  • Validity and contract tracking
Insurance and TPA Master Management Software

Pre-Authorization Request & Approval Tracking

  • Pre-auth request creation
  • Medical documents & estimates upload
  • Approval, query & rejection tracking
  • Auto alerts for pending approvals
Insurance Pre Authorization Management Software

IPD Billing & Insurance Linkage

Ensure accurate billing aligned with insurance rules and approved limits.

  • Package and non-package billing
  • Auto segregation of insurer & patient share
  • Real-time utilization vs approval tracking
  • Excess and co-pay calculation

Claim Submission & Settlement Tracking

Digitize post-discharge insurance workflows to speed up claim settlements.

  • Claim document checklist
  • Submission date & TAT tracking
  • Settlement amount reconciliation
  • Shortfall and deduction tracking

Integrated TPA & Insurance Workflow

Insurance module is tightly integrated with OPD, IPD, EMR, OT, billing, pharmacy, diagnostics, and payments.

This ensures zero duplication and complete claim traceability.

  • Admission → Pre-Auth → Treatment
  • Billing → Claim → Settlement
  • Insurance + patient financial clarity
  • Single insurance patient record
  • Insurance company-wise claims
  • TPA-wise approval & rejection analysis
  • Pending claims ageing
  • Settlement vs billed amount reports

Insurance & TPA Reports & Analytics

Gain visibility into insurance performance, cash flow, and claim efficiency with real-time analytics dashboards.

Security, Compliance & Audit Readiness

Insurance workflows must meet regulatory, audit, and data security standards.

SWI HMS ensures secure access, documentation traceability, and NABH-aligned insurance processes.

  • Role-based insurance access
  • Time-stamped insurance actions
  • Complete audit trails
  • NABH-ready insurance documentation

Why Choose SWI for TPA & Insurance Management?

Faster Approvals · Fewer Rejections · Better Cash Flow · NABH-Ready

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