Revenue cycle advisory
Revenue Cycle Management in India
We set up the revenue cycle for a mixed payer base: cashless pre-authorisation, discharge documentation, claim submission including NHCX where insurers use it, scheme claims on their own portals, query responses and a deductions and denials log by payer. Owners get a clear monthly view of billed, pending and settled amounts.
The rules of the ground
Who regulates and pays in India
IRDAI regulates health insurers and the third-party administrators that process many of their claims. For a private hospital, cashless access to a patient's policy depends on empanelment with each insurer or TPA network and on agreed package tariffs, and claims are increasingly moving onto the National Health Authority's National Health Claims Exchange (NHCX). Government schemes form a second channel: Ayushman Bharat PM-JAY and the state schemes that run alongside it, plus CGHS and ECHS panels for central government and ex-servicemen beneficiaries. Each payer has different rates, documentation and payment timelines, so the right mix is a commercial decision taken at setup, not after opening.
Regulates medical education and practice nationally and maintains the national medical register, while state medical councils register the doctors who practise in each state.
A board of the Quality Council of India that accredits hospitals, clinics and small healthcare organisations, with entry-level standards that give smaller facilities a realistic first step.
Regulates health insurers and third-party administrators, including the rules on cashless treatment, claims settlement and the networks through which private hospitals receive insured patients.
Runs Ayushman Bharat PM-JAY with the State Health Agencies, leads the Ayushman Bharat Digital Mission and operates the National Health Claims Exchange used for insurance claims.
Scope
What we deliver in India
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
What does a healthcare consultancy in India do for a new hospital or clinic?
Is NABH accreditation mandatory for private hospitals in India?
Which law governs clinic and hospital registration in India?
Where does Tulazai Health work in India?
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.