Hospitals lose 3–7% of insurance revenue to avoidable deductions. The pattern behind most of them: documents assembled manually at discharge, hours before the patient wants to leave.
The fix is structural. Pre-authorisation should pull the treating doctor's notes, estimates and tariff mappings directly from the HIMS, not from photocopies. Query responses should be tracked with SLAs. And the discharge checklist should block the file until every insurer-required document is attached.
When the TPA desk works from the same live record as the clinical team, settlement times collapse — our customers average 11 days from discharge to settlement.