Insurance & TPA Management
Cashless treatment, pre-authorisation and claims — all managed within your HMS.
What is Insurance & TPA Management?
The Insurance module manages the complete patient insurance lifecycle — policy registration, pre-authorisation requests, claim submission and reimbursement tracking. It supports cashless treatment by enabling bill splitting between patient and insurer.
Insurance processes that typically involve multiple phone calls, faxes and emails are streamlined into a single digital workflow. Raise pre-auth, attach documentation, submit and track response — all within Odoo.
The module supports multiple insurance companies and TPAs simultaneously, each with their own templates, tariff agreements and claim formats.
Key Features
Everything Insurance & TPA Management brings to your hospital to streamline operations and improve patient care.
Insurance Policy Management
Store patient policies — company, coverage, sum insured, co-pay, deductible. Link to patient record.
Pre-Authorisation
Raise pre-auth requests for admissions and surgeries. Attach clinical docs. Track TPA responses.
Claim Submission
Submit claims electronically or generate TPA-specific formats. Track status from submission to settlement.
Cashless Treatment
Split invoices between patient and insurer at billing. Insurance portion submitted as claim.
TPA Management
Manage multiple TPAs with their own tariffs, pre-auth formats and claim templates.
Use Cases
See how healthcare providers use Insurance & TPA Management in practice.
Insurance-Heavy Hospital
A hospital processing 65% insured patients reduced claim rejection from 15% to 4%. Average settlement dropped from 45 to 18 days.
Why it matters
The measurable value Insurance & TPA Management delivers to your hospital, staff and patients every day.
See the full HMS feature listWorks great with
Combine Insurance & TPA Management with these connected modules for a complete solution.
More Administration Modules
Explore other modules in this category.
Ready to bring Insurance & TPA Management to your hospital?
It is just one module inside the complete AlmightyHMS suite.
Install once and get the total solution for your hospital.