TPA na chuna ho to 'Pick a TPA above to run validation.' aata hai; upar '(N blocking · N warn · N pass)' ginti hoti hai. Checklist draft banate waqt ki hai — ICD / procedure code ka ✗ dikhe to ghabrao nahi, '✓ Mark Approved' dabate hi ye codes claim par save hote hain aur TPA email me jaate hain. Kuch ✗ aise hain jinhe screen se bharne ki jagah abhi nahi hai — jaise 'Member name as per policy' aur doctor registration number wala item (doctor ka Reg no. sirf neeche footer me dikhta hai) — ye app ki kami hai. Blocking ✗ hone par bhi app submit nahi rokta. Attachments sirf suggestion hain: X-ray / consent email ke saath apne aap nahi jaate, TPA ko alag se bhejo. '⚠ Red Flags:' = claim reject hone ke khatre.
AI claim package me 'TPA Rule Checklist' aur 'Suggested Attachments' ka matlab?
'✅ TPA Rule Checklist' chune hue TPA ke niyam se claim jaanchta hai: ✓ = theek, ⚠ = dhyan do, ✗ = blocking kami (jaise ICD code, policy number). '📎 Suggested Attachments' batata hai kaunse saboot chahiye: 'auto-matched' = patient ka matching X-ray mil gaya, 'missing' = X-ray nahi mila, 'todo' = scan document (consent, Aadhaar) lagana baaki.
Where in ORALZY: Billing → Insurance & RGHS → Insurance
Quick steps
- Claim row → '🤖 AI Generate' → 'TPA:' chuno → '🔁 Regenerate'
- '✅ TPA Rule Checklist' me ✗ / ⚠ items padho
- '📎 Suggested Attachments' me 'missing' / 'todo' wale saboot taiyar karo
- TPA ko X-ray / documents alag se bhejo