Revenue cycle advisory
Revenue Cycle Management in Indore
We set up pre-authorisation, discharge summary and claim file standards for TPA and scheme patients, track queries and deductions by payer, and train the billing desk to close files on time. For hospitals moving from mostly cash to mostly cashless admissions, this is usually where cash flow is won or lost.
The rules of the ground
Who regulates and pays in Indore
Indore's payer mix is changing quickly. Cash still matters, especially for day-care and diagnostics, but a growing share of admissions now comes through private insurers and TPAs, the corporate policies of employers in and around the city, and Ayushman Bharat Niramayam for eligible families. ECHS panels also matter for some hospitals. Each channel pays different rates on different timelines, so an Indore hospital needs to choose its empanelments deliberately and track pending claims by payer rather than as one total.
Registers and inspects private nursing homes and clinical establishments in Indore district under the Madhya Pradesh Upcharyagriha Tatha Rujopchar Sambandhi Sthapnaye (Registrikaran Tatha Anugyapan) Adhiniyam, 1973 and its rules.
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 expects segregation, storage and disposal records to match what the facility was authorised for.
Implements Ayushman Bharat PM-JAY in Madhya Pradesh, empanels private hospitals by specialty and processes pre-authorisations and claims for eligible beneficiaries.
Scope
What we deliver in Indore
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 do hospital consultants in Indore help with?
Who registers a private hospital or clinic in Indore?
How can an Indore hospital join Ayushman Bharat Niramayam?
Where is Tulazai Health's Indore office?
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.