Insurance Claims Management
Claims processing, rejected claims tracking, and insurance company management
The Insurance Desk module manages the complete insurance claims lifecycle. It handles TPA registration, claim submission, pre-authorization workflows, rejected claims tracking and re-submission, and insurance company/TPA master management.
Key Highlights
Complete Claims Lifecycle
From pre-authorization to final settlement — track every insurance claim through its entire journey.
Rejection Management
Track why claims are rejected, fix issues, and re-submit — with full audit trail.
TPA-Specific Formats
Generate claim documents in the specific format required by each TPA — no manual reformatting.
Complete Feature List
Everything included in the Insurance module.
Claims Processing
Submit insurance claims with TPA-specific documentation and formats
Pre-Authorization
Track pre-authorization requests and approvals for planned procedures
Rejected Claims
Track rejected claims with rejection reasons and re-submission workflow
Insurance Company Master
Maintain TPA/insurance company details, contact persons, and claim formats
Claim Reports
Reports on claim status, rejection rates, and outstanding amounts per insurer
AI Enhancements for Insurance
This module is being enhanced with AI capabilities.
Smart ICD-10 Coding Assistant
AI suggests accurate ICD-10 codes from clinical notes and diagnosis descriptions.
Impact: Accurate coding without specialized staff
Insurance Pre-Authorization AI
Auto-generates pre-auth requests, checks coverage, and assembles supporting documentation.
Impact: Pre-auth in minutes, not hours
Claims Denial Prevention
AI reviews claims before submission — checks for common denial triggers and suggests corrections.
Impact: Reduce rejection rates by 30-40%
Integrates With
Insurance connects seamlessly with these HIMS modules.
Frequently Asked Questions
Can HIMS handle insurance pre-authorization?
Yes, HIMS includes a pre-authorization workflow that tracks requests, approvals, and links them to inpatient admissions.
See Insurance in Action
Book a free demo to explore the Insurance Claims Management module and the rest of HIMS.