Centralized Billing Master Data, Insurance Configuration & TPA Management
Centralized billing master data with payer management, TPA configuration, tariff plans, and billing rules.
Key Benefits
Pricing
Module price
Select this module now. Duration and final pricing are configured at checkout.
Base module price
Duration, users and final amount will be selected during configuration.
- ✓Accurate Claims
- ✓Consistent Billing
- ✓Efficient Verification
- ✓Compliance Ready
Challenge & Solution
The Problem We Solve
The Challenge
Billing master data—payers, insurance companies, TPA, tariffs—is inconsistent. Claims are rejected due to incorrect payer information. Insurance verification is manual.
The Solution
The Medical Billing Masters module provides centralized billing master data—payer and insurance company management, TPA configuration, tariff plans, and billing rules. Single source of truth for billing master data.
Key Features
What It Does
Payer & Insurance Company Management
Insurance company registration with complete details. Payer configuration with billing rules. Insurance verification and eligibility checking. Payer communication and document management.
TPA Configuration & Management
TPA registration with complete details. TPA-specific billing rules and tariffs. TPA claims processing configuration. TPA communication and reconciliation.
Tariff Plans & Packages
Tariff plan creation with multiple price lists. Department and service-specific tariffs. Package tariffs with bundled pricing. Tariff effective dates and versioning.
Billing Rule Configuration
Billing rules—taxes, discounts, adjustments, rounding. Payer-specific and service-specific rules. Rule priority and override settings. Rule versioning and change tracking.
Audit & Compliance
Complete change history for billing masters. Approval workflow for changes. Audit trail for billing configuration. Compliance documentation for audits.
Workflow
How It Works
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Step
1Step 1: Payer and Insurance Configuration
Insurance companies are registered. Payers are configured with billing rules. Verification processes are established.
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Step
2Step 2: TPA Configuration
TPAs are registered. TPA-specific rules and tariffs are configured. Claims processing is set up.
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Step
3Step 3: Tariff Plan Creation
Tariff plans are created with multiple price lists. Department and service-specific tariffs are defined.
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Step
4Step 4: Billing Rule Configuration
Billing rules are configured. Payer-specific and service-specific rules are defined. Rule priority is set.
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Step
5Step 5: Change Management and Audit
Changes are submitted and approved. Audit trail is maintained. Compliance is documented.
Reports
Analytics & Reports
Real-time insights and exportable reports built into every workflow.
Payer & TPA Configuration Report
Payer and TPA configuration, billing rules, and tariff mapping.
Tariff Plan & Pricing Report
Tariff plans, price lists, and pricing effectiveness.
Billing Master Change Audit Report
Billing master changes, approval history, and compliance status.
Operator Impact
What Changes for You
Accurate Claims
Correct payer and TPA configuration reduces claim rejections.
Consistent Billing
Standardized tariffs and billing rules.
Efficient Verification
Insurance verification and eligibility checking.
Compliance Ready
Complete audit trail for billing master changes.
FAQ
Frequently Asked Questions
How are insurance companies managed?
Registration with complete details. Payer configuration with billing rules. Verification and eligibility checking.
How is TPA management handled?
TPA registration with complete details. TPA-specific rules and tariffs. Claims processing and reconciliation.
Can we have multiple tariff plans?
Yes, multiple tariff plans with price lists. Department and service-specific tariffs.
How are billing rules configured?
Taxes, discounts, adjustments, rounding. Payer-specific and service-specific rules.
Ready to add MEDICAL BILLING MASTERS?
Part of the Medical Billing suite