From discharge to payment: tracking every claim without a spreadsheet
Knowing where each claim stands, and what was deducted, is how a hospital gets paid in full.
Sending the file is the middle of the claim, not the end. Between submission and money in the bank there are queries, settlement letters, deductions, TDS and sometimes a payment that never arrives.
One record per claim
Each claim needs one place that shows its stage (submitted, query, settled, payment received), the amounts (billed, approved, settled, received) and the dates. When that record is shared by the TPA desk and finance, nobody has to ask.
Watch the deductions
Deductions are where money quietly goes missing. Record every deduction with its reason. Over a quarter, the pattern shows which payer deducts what, and which of those deductions can be fought.
Age the outstanding
Group unpaid claims by how long they have been outstanding: under 30 days, 30 to 60, 60 to 90, over 90. The oldest group is where follow-up should start every week.
Reconcile with the bank
Match each payment in the bank statement to its claim using the UTR. Anything left unmatched is either a payment you did not expect or a claim you have not been paid for, and both need a call.
More from the blog
Build a final file checklist your whole hospital can follow
A good checklist is short, ordered the way the file is assembled, and says who owns each line.
Why cashless claims get queried, and how to stop it at the desk
Most TPA queries come from a short list of gaps that can be caught before the file leaves the hospital.