Dhyan: 'Submit' button TPA ko kuch nahi bhejta — ye sirf claim ko 'submitted' mark karta hai aur claim date aaj ki rakhta hai. TPA ko asli pre-auth email '🤖 AI Generate' → '📤 Submit to TPA' se jaata hai. 'Deny' me reason khaali chhodo to kuch save nahi hota; reason ke shabd (jaise OPG, cosmetic, not covered, expired) se '📊 TPA Analytics' ke 'Top Denial Reasons' bante hain. Settle me ₹0 bhi daal sakte ho. Settled / denied ke baad koi status button nahi bachta — galti ho to wapas nahi hota. Settle karne se patient ka bill ya due nahi badalta.
Insurance claim ko Submit, Under Review, Settle ya Deny kaise kare?
Billing → Insurance & RGHS → Insurance → Claims tab → claim ki row ke Actions: draft par 'Submit', submitted par 'Under Review', submitted / under-review par 'Settle' (poochta hai 'Settled amount:') aur 'Deny' (poochta hai 'Denial reason:'). Har button sirf claim ka status badalta hai; 'Settle' ₹ aur aaj ki date claim par likh deta hai.
Where in ORALZY: Billing → Insurance & RGHS → Insurance
Quick steps
- Billing → Insurance & RGHS → Insurance kholo (Claims tab)
- Claim ki row me 'Submit', phir TPA dekhne lage to 'Under Review' dabao
- Paisa pass ho to 'Settle' → settled amount likho
- Reject ho to 'Deny' → reason likho