HIMS bills every admission from the treatment record, whatever the payer: cash, insurance or a TPA. Pre-authorisation, enhancements, claim documents and the outstanding owed by each TPA are tracked in the same system that produced the bill.
Hospital TPA and insurance billing software handles the part of billing where the patient is not the only payer. A cashless admission needs a pre-authorisation before treatment, enhancements during the stay, a claim with supporting documents at discharge, and then months of follow-up until the TPA settles. HIMS keeps the cash portion, the insured portion and the TPA claim on the same bill, all drawn from the same treatment record.
The reason this matters is mismatch. A claim is queried or rejected when the documents do not agree with the bill, or the bill does not agree with the treatment. When billing pulls from the record rather than being typed afresh, the discharge summary, the itemised bill and the claim form describe the same admission. GST is applied to the hospital services where it applies, using the rules your accountant configures.
The patient pays some, the insurer approves some, and the TPA pays later. Most hospitals track this in three places.
The status of a pre-authorisation lives in the TPA coordinator's phone, and nobody else can answer the family.
The bill is typed at the counter and the claim form is typed at the TPA desk, and the two never quite match.
The stay extends but the approved amount does not, and the difference lands on the patient at discharge.
Discharge summary, investigation reports and the itemised bill are photocopied from different places and one is always missing.
Money settled, part-settled and disallowed by each TPA is in a ledger that only accounts can read.
At admission the insurer, TPA and policy details go on the record.
Estimated package and diagnosis sent; approval and approved amount logged.
Room, pharmacy, lab, OT and consultant fees post to the running bill.
As the stay extends, an enhancement request is raised against the same case.
Itemised bill, discharge summary and reports compiled from the record.
Approved, queried, disallowed and paid amounts recorded per TPA.
Workflow: Anyone at the front desk opens the admission and sees the pre-auth status and approved amount.
Result: The answer does not depend on one coordinator.
Workflow: The lab report is on the record; the TPA desk attaches it and resubmits from the same case.
Result: The query is answered the same day.
Workflow: Accounts filter claims by TPA and status to see what is filed, queried, part-paid and disallowed.
Result: Follow-up goes to the right TPA for the right amount.
Workflow: The approved amount covers part of the bill; the balance is collected at discharge with a receipt on the same bill.
Result: One bill, two payers, no reconciliation later.
Cashless admissions every week.
Insurance cases without a dedicated TPA desk.
Pre-auth, enhancement and claim in one place.
Outstanding per payer without a side ledger.
Answer a bill query while the family is standing there.
Yes. The bill records the amount approved by the insurer or TPA and the balance payable by the patient, so a top-up is collected at discharge with a receipt on the same bill rather than a second invoice.
The itemised bill, discharge summary and investigation reports are on the same record as the admission, so the TPA desk compiles them from the case instead of collecting photocopies from departments. See IPD software for the record side.
HIMS prepares the bill and documents and tracks status. Submission to each TPA follows that TPA's own process. If you need a specific portal workflow, describe it on the call and it is scoped with the project.
Billing in HIMS is GST-native. Tax is applied to the services and items where your accountant says it applies and left off where it does not; the rules are configured during setup. This is a billing feature, not tax advice, so confirm treatment with your auditor.
Yes. Claims are filtered by payer and status, so accounts can see filed, queried, part-paid and disallowed amounts per TPA, and the collections dashboard shows what has actually come in.
No. TPA and insurance billing is part of the HIMS billing module, alongside cash billing, packages and deposits. Read the hospital billing software page for the whole billing flow.
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