The claim is approved in an hour. Your paperwork takes a week.
Insurance has quietly become the fastest-moving part of a hospital's day. Under IRDAI's Master Circular on Health Insurance Business, in force since 2024, insurers are required to decide a cashless pre-authorisation request within one hour, and to grant final authorisation at discharge within three hours — with the cost of any delay beyond that falling on the insurer, not the patient. For patients this is a genuine relief. For a hospital or clinic whose billing desk, TPA coordination and records are not ready to move at that pace, the same speed becomes a problem: the approval is quick, but the deductions, the missing documents and the unreconciled settlements all land back on you.
Where TPA money actually leaks
Ask any hospital administrator where insurance revenue disappears and you will hear the same handful of answers. None of them are dramatic; all of them are avoidable with the right records:
- Pre-authorisation raised late or with incomplete documents, delaying the whole admission.
- A tariff mismatch between what was billed and the package the TPA actually approved.
- Non-payable items billed to the insurer, then knocked off at settlement.
- Documents missing at the settlement stage, so a valid claim is held or reduced.
- Deductions that are never reconciled, so nobody knows the real realisation rate.
- Pending claims that simply stop being followed up after a few weeks.
What the back office needs to track
The cure is not more staff chasing paper; it is a system where every insured patient is a tracked case from admission to money-in-the-bank. That means holding, in one place:
- A clean mapping of patient to policy to TPA for every admission.
- Live pre-authorisation status, so nothing waits on a phone call.
- The approved package set against actual billing, item by item.
- Deduction reconciliation, so every rupee knocked off has a reason.
- Settlement ageing, so pending claims are chased before they are forgotten.
Practo, HealthPlix and Eka.care — named fairly
These are good products and they are good at what they set out to do. Practo, HealthPlix and Eka.care are EMR-first and consult-first: appointments, prescriptions, clinical notes and patient records, often with a clean doctor-facing experience. If your priority is the consulting room, they are worth a serious look. But the insurance money does not flow through the consulting room. It flows through billing, pharmacy, the TPA desk and the settlement file — the back office that EMR-first tools largely leave for you to run on spreadsheets and goodwill.
ABDM and ABHA, bundled instead of billed
There is one more quiet cost worth naming. ABDM and ABHA support — linking records to the national health stack — is increasingly expected, and several platforms treat it as a paid add-on, sometimes 20 to 30% on top of the base price. We think that is the wrong way round for something that is becoming basic infrastructure, so in BizRevolt it is bundled in rather than sold back to you as an upgrade.
A cashless approval you cannot bill against cleanly is not revenue yet — it is just a promise on a form.
Where BizRevolt fits
BizRevolt's clinic and hospital workspace is deliberately built around the back office the EMRs skip: billing, pharmacy and inventory, insurance and TPA from pre-authorisation to settlement, ward occupancy, and a full audit trail — with ABDM and ABHA bundled in, not billed extra. Pricing is ₹799 per doctor and ₹1,399 per doctor for richer tiers, or ₹150 per bed for in-patient setups, so a clinic and a nursing home can each pay for what actually fits their shape. The first reconciled TPA settlement usually more than covers the month.
If your insurance realisation is a number nobody in the building can quote you with confidence, that is the tell. Message or call the founder directly on +91 91 0657 4865 and we will walk your pre-auth-to-settlement flow with you, honestly, before you commit to anything.
Follow-ups, deposits and the money left on the table
There is a second, quieter leak that sits right next to the insurance one. When a patient is discharged, there is usually an excess deposit to refund, a co-pay to collect, and a follow-up visit that should be booked but often is not. In a busy hospital these slip through constantly: the deposit refund is delayed until the patient complains, the small co-pay balance is written off because chasing it feels petty, and the follow-up that would have brought the patient back in three weeks simply never gets scheduled. None of these is large on its own. Together, across a month of discharges, they are a meaningful share of what a mid-sized clinic actually earns.
- Excess admission deposits refunded promptly, with a clear record, so trust is not lost at the exit.
- Co-pay and non-payable balances collected at discharge, not written off by default.
- Post-discharge follow-up visits scheduled before the patient leaves the building.
- Pharmacy and procedure charges reconciled against the final bill so nothing is billed twice or missed.
The point is not to squeeze the patient; it is to stop giving away money and goodwill by accident. A back office that closes each admission cleanly — deposit settled, co-pay collected, follow-up booked — is also the one patients trust enough to come back to.
To be plain about it: we are not asking you to rip out the EMR your doctors already like. Keep it. BizRevolt is built to run underneath and around it, owning the billing, pharmacy, TPA and settlement layer that clinical tools were never really meant to carry. The two can coexist, and in most hospitals they genuinely should — the doctor keeps their familiar screen, and the back office finally gets one built for its actual job.