Every TPA.
One app
ClaimIQ is one workspace where a private hospital in India submits, tracks and collects every insurance claim, from admission to the rupee landing in its bank account, across every TPA and insurer.
Needs action
The insurance desk spends its day on portals, inboxes and spreadsheets.
Portal by portal
Staff log in to each TPA portal separately, wait for an OTP on someone's phone or mailbox, re-type the same patient details and upload the same papers in a different order for each payer.
Queries lost in mailboxes
Payer queries arrive by email or portal and get missed. Pre-auth and claim deadlines lapse without anyone noticing until the cash does not arrive.
Credits that never match a bill
Settlements land as bulk bank credits with changed claim numbers, partial amounts and TDS. Finance spends days matching bank lines to bills while receivables age.
One case record, from admission to the bank credit.
Every step stays on the same case, so the desk, claims and finance teams work from one picture.
- 01
Scan the card, start pre-auth
ClaimIQ reads the member ID, policy, patient and TPA from the insurance card and fills the admission and pre-auth form.
- 02
Submit by portal or email
Send to the TPA from one screen. The OTP is captured from the hospital mailbox and the acknowledgement is recorded on the case.
- 03
Work the queue
A Needs action list with live SLA timers brings queries, approvals and follow-ups to the top, with each email linked to its case.
- 04
Settle
See payments, TDS and deductions by category side by side, and keep the top sheet against closure.
- 05
Reconcile bank credits
Import the bank statement, match credits to bills, including bulk credits, and send the rest to an exceptions queue.
Everything an insurance desk and its finance team need.
Twelve modules on one case record.
New admission and pre-auth
Scan the insurance card, check the form and submit, with the TPA's channel picked for you and ABHA health records ready to link.
Submissions
Signs in to the TPA portal or emails the TPA, captures the OTP from the hospital mailbox, uploads, records the acknowledgement and retries safely.
Worklist
A Needs action list with SLA timers, status colours, filters and saved views, plus Excel exports and bulk upload.
Syncs the hospital mailbox, links each mail to its case and flags queries, approvals and settlement advices.
Claim pack
Splits uploaded documents into the ten enclosure types, orders them per payer, compresses to the payer's size limit and builds one bookmarked PDF.
Bill audit
Checks the bill against payer rules before submission and helps predict deductions from room-rent caps, non-payables, package rates, sub-limits and duplicates.
Settlements
Side-by-side payment view with TDS and deductions by category, and a top sheet PDF kept against closure.
Bank reconciliation
Reads Excel, CSV, MT940 and PDF statements and matches credits to bills, including bulk credits and changed claim numbers.
Dashboard and reports
A role-based dashboard with ageing, TPA-wise outstanding and deduction analysis, and report views that drill down to the cases behind each number.
TPA connections
Save each TPA login once, then see which TPAs are ready, how each is reached and what failed today.
History import and integrations
Import past cases from Excel with checks and an undo, and connect your hospital system through our API and webhooks.
Administration
Users, roles, payers and branches, with role-based access, an audit log, backups, data retention and patient data requests.
Every TPA and insurer can be reached by email from day one; portal submission is switched on TPA by TPA.
Automation that does the work, not just records it.
ClaimIQ takes the repetitive, error-prone steps off the insurance desk. People stay in charge of what is sent and what is confirmed.
- Reads the insurance card and fills the admission and pre-auth form
- Assembles the claim pack, split, ordered and sized for each payer
- Applies payer rules to the bill so likely deductions are flagged before submission
- Links incoming email to the right case and flags queries and settlement advices
- Matches bank credits to bills and queues exceptions for review
Matching accuracy is measured on your own data, not quoted in advance.
Built for the hospital's claims team and the people who depend on it.
Private hospitals
Single-branch and multi-branch hospitals in India that treat cashless and reimbursement insurance patients.
Insurance desk and claims
Pre-auth, claim packs, queries and follow-ups from one worklist, without portal logins or OTP chasing.
Finance and management
Outstanding by TPA, ageing, deductions and bank matching on one live dashboard.
Common questions
Which TPAs and insurers does ClaimIQ work with?
Every TPA and insurer can be reached by email from day one. Submission into each TPA's web portal is switched on TPA by TPA during onboarding, so we connect to your TPAs' portals rather than claim every portal is live today.
What if a TPA has no portal?
ClaimIQ submits by email. The claim pack is built the same way, the submission is recorded on the case, and replies are linked back to it.
How does onboarding work?
We set up your users, branches and TPA logins, import past cases from Excel if you want them, and switch on portal submission TPA by TPA. We will agree the plan with you for your hospital.
How are our data and TPA logins protected?
Files are encrypted at rest (AES-256) and all traffic is encrypted in transit. Every user action is recorded in an audit log and access is role-based. TPA logins are stored encrypted, used only to submit your hospital's claims, and never shown again. Production data is hosted in India.
Can ClaimIQ connect to our HIS or ERP?
Yes. ClaimIQ integrates with your hospital system through our API for an admission and bill feed, and supports webhooks. Each hospital needs its own setup.
How is ClaimIQ priced?
Monthly subscription per hospital by claim volume — ask for a proposal.
See ClaimIQ on your own claims.
Book a demo, then talk to us about a pilot on your hospital's own TPAs.