Revenue cycle advisory
Revenue Cycle Management in Gurugram
We build cashless workflows that keep pace with corporate patients' expectations: eligibility at admission, pre-authorisation and enhancement requests, discharge documentation, claim submission and a deductions log by insurer and TPA. Weekly reviews show where money is lost and who fixes it.
The rules of the ground
Who regulates and pays in Gurugram
Gurugram is one of the most insurance-heavy markets in India. Employees of multinational and Indian companies hold group policies administered by TPAs, many families add retail cover, and insurers negotiate firmly on package rates and room categories. CGHS panels are relevant for some providers in Delhi NCR, and Chirayu Haryana extends Ayushman Bharat PM-JAY cover to more families in the state. International patients, mostly self-pay or covered by overseas insurers and facilitators, form a separate channel with its own expectations on pricing and communication.
Registers clinical establishments in Gurugram district under the Act as adopted by Haryana, starting with provisional registration and moving to permanent registration once the facility meets the notified minimum standards.
Maintains the state register of medical practitioners within the National Medical Commission framework; we check registration status for every doctor before they join the roster.
Grants authorisation under the Bio-Medical Waste Management Rules, 2016, and reviews how waste is segregated, stored and handed over for disposal.
Decide network entry, package tariffs and cashless approvals for the corporate and retail policies that most Gurugram patients carry.
Scope
What we deliver in Gurugram
End-to-end RCM audit
A sample-based review of encounters from registration to remittance, identifying where claims fail, what the root causes are and how much value sits in unworked rejections and underpayments.
Front-end eligibility and prior authorisation
Registration scripts, eligibility checks and prior authorisation workflows redesigned so coverage, benefits and approvals are confirmed before treatment, not discovered after the claim is rejected.
Clinical documentation and coding review
Coding accuracy reviewed against ICD-10-CM and CPT in the UAE, or ICD-10-AM and the Saudi Billing System in KSA, with documentation feedback for doctors and targeted coder training.
E-claims submission and scrubbing rules
Claim validation rules configured and tested for eClaimLink and DHPO, Shafafiya or NPHIES, so formatting, code pairing and mandatory field errors are caught before the claim leaves your system.
Denial management and resubmission
A categorised denial log, root-cause analysis by payer and reason, resubmission templates and a daily work queue, so every rejection is either recovered or consciously written off within the payer's deadline.
Contract loading and remittance reconciliation
Payer price lists and contract terms loaded accurately into your HIS, and remittance advices reconciled line by line, so underpayments are identified and disputed rather than silently absorbed.
Process
How the work runs
Baseline
We extract claims, rejection and remittance data by payer and establish your current rejection patterns, ageing profile and cash conversion before recommending anything.
Root-cause analysis
Every major rejection category is traced back to its true source: registration, authorisation, clinical documentation, coding, system configuration or contract loading.
Fix the process
Workflows, system rules, templates and training are corrected at the source, starting with the causes that account for the largest share of lost revenue.
Recover the backlog
In parallel, recoverable rejections and underpayments still inside payer resubmission windows are worked in priority order, so the project starts paying back early.
Monitor and hand over
A weekly RCM dashboard and review routine are handed to your team, with optional ongoing oversight of an in-house or outsourced billing function.
Frequently asked questions
Why work with healthcare consultants in Gurugram rather than managing setup in-house?
Does the Clinical Establishments Act apply in Gurugram?
How long does TPA empanelment take for a new clinic in Gurugram?
Can you help a Gurugram hospital attract international patients?
What does revenue cycle management include for a GCC clinic or hospital?
Do you handle NPHIES and Saudi Billing System coding in KSA?
Complimentary 30-minute call
Talk it through with a senior consultant.
Tell us where your facility is today and where you want it to be. You leave the call with a clear next step.