Skip to main content

🛡️ Insurance Claims & Cashless Pre-Authorization Guide

This guide provides step-by-step instructions for TPA Officers and Billing Managers to process cashless insurance pre-authorizations, upload discharge documents, and track claim settlements in Medzit NexHealth HMS.

📌 Insurance Claim Lifecycle​

📄 1. Submitting Cashless Pre-Authorization​

  1. Open Insurance & Claims from the sidebar (/insurance).
  2. Click + New Pre-Auth Request.
  3. Select Patient MRN and Payer Insurance Company.
  4. Enter Estimated Package Cost, Room Category, and Expected Length of Stay.
  5. Attach Doctor Initial Assessment Form & ID Proof.
  6. Click Submit Pre-Auth to TPA Portal.

💰 2. Tracking Approval & Claim Settlement​

  • Approved Amount: Update pre-approved sum limit (e.g. $3,500 / ₹2,50,000).
  • Co-Pay / Deductible: System automatically calculates patient co-pay responsibility at cashier desk.
  • Claim Document Dispatch: Upload signed discharge summary, itemized final bill, and pharmacy vouchers upon discharge.
  • Settlement Reconciliation: Mark claim settled when insurance payment is credited to hospital bank account.
Was this documentation page helpful?

Help us improve Medzit NexHealth HMS documentation for hospital staff.

Last updated on