Denial Rate = Denied ÷ (Settled + Denied). Recovery % = kul Settled ₹ ÷ kul Claim ₹ — isme draft / pending claims ka amount bhi ginta hai, isliye pending zyada ho to % kam dikhega. Avg TAT (days) = claim date ('Submit' wala din) se settle date tak, sirf settled claims ka. Top Denial Reasons 'Deny' me likhe reason ke shabdon se bante hain (jaise missing-opg, cosmetic-not-covered, plan-exclusion, other); bina TPA wale claims ke reasons kisi row me nahi dikhte. Mobile ka Insurance → 'TPA Score' tab alag hai — wo Insurance Company ke naam se ginta hai.
TPA Analytics me claims 'unassigned' kyu dikhte hain?
'📊 TPA Analytics' claims ko us TPA se jodta hai jo claim ke '🤖 AI Generate' drawer me 'TPA:' me chuna gaya — Insurance Company ya uske 'TPA Name' se nahi. Jis claim me TPA kabhi chuna hi nahi, wo 'unassigned' row me jaata hai. Sahi report ke liye har claim par AI Generate kholkar TPA chuno aur '🔁 Regenerate' ya '✓ Mark Approved' dabao (tabhi TPA claim par save hota hai).
Where in ORALZY: Billing → Insurance & RGHS → Insurance
Quick steps
- Billing → Insurance & RGHS → Insurance → '📊 TPA Analytics' kholo
- 'unassigned' row ke claims Claims tab me dhundo
- Har claim par '🤖 AI Generate' → 'TPA:' chuno → '🔁 Regenerate' ya '✓ Mark Approved'
- Analytics tab dobara kholo