Corporate & TPA Operations
Simplify Corporate & TPA Operations
Bring authorizations, documents, payer queries and claims into one connected workflow.
Case #10482
Pre-authorization
- Documents ready
- Awaiting payer response
- Current status
- Under review
The reality
One patient case can involve multiple payer steps.
Authorization requests, supporting documents, payer queries and claims can move between hospital teams and external payer workflows. Keeping every step visible is critical to keeping the case moving.
The hospital problem
Pre-authorization takes time to complete.
A hospital may need to submit patient information, clinical details, treatment information, estimates and supporting documents before a payer or TPA can process an authorization request.
The TPA desk needs to know exactly where every authorization stands and what needs to happen next.
TPA desk “Where has this authorization actually reached?”
- Patient
- Anita Sharma
- Payer
- ABC Insurance
- TPA
- XYZ TPA
- Estimated amount
- ₹1,25,000
- Patient details
- Clinical information
- Treatment details
- Estimate
- Supporting documents
How Wisemelon connects it
Manage every authorization from one place.
Give the TPA desk one operational view of authorization status, required information, pending actions and payer responses.
The hospital problem
Missing documents delay approvals.
Payer and TPA workflows can require specific clinical, financial or supporting information. The desk needs to know what is missing, who has it, whether it has been requested and whether it has been submitted.
- Patient detailsFront desk
- Doctor's notesClinical
- Investigation reportsDiagnostics
- Treatment planClinical
- EstimateBilling
- Supporting documentDiagnostics
2 documents requiredBefore submission
How Wisemelon connects it
Know what is missing before you submit.
Keep required documents connected to the authorization case and notify the responsible team when something is still needed.
Document required
- Patient
- Anita Sharma
- Case
- #10482
- Missing
- MRI report
- Required for
- Pre-authorization
- To
- Diagnostics
- Required
- MRI report
- Case
- #10482
- Reason
- Required for authorization
Payer requirement → hospital action → document → authorization
6 of 6 documents complete Case #10482
The hospital problem
Payer queries require repeated follow-ups.
A payer or TPA may request additional clarification. The desk needs to know which queries are pending, who is preparing the response and whether the response has been submitted.
How Wisemelon connects it
Keep every payer query connected to the case.
Case #10482
“Please provide additional clinical justification.”
- Received
- 10:42 AM
- Assigned to
- Clinical Desk
Query receivedABC Insurance
Assigned to Clinical Desk
Response prepared
Submitted to payer
Query resolved
The hospital problem
Claims need to be tracked after submission.
The operational work does not end when a claim is submitted. The desk needs visibility from claim submission through final resolution.
How Wisemelon connects it
Track the claim from submission to settlement.
- Claim amount
- ₹1,25,000
- Approved amount
- ₹1,18,000
- Deduction
- ₹7,000
- Payment status
- Received
- Case
- #10482
- Reason
- Additional supporting documentation required
Next action — review & respond TPA Desk
The reason shown is the one returned on the case. Wisemelon records it; it does not determine it.
Patient communication
Keep the patient informed when the status changes.
Hospital teams see what happened, and patients receive the update the hospital has configured.
Claim approved
Your insurance claim has been approved.
- Approved amount
- ₹1,18,000
- Hospital
- ABC Hospital
View details
Claim status update
Your claim could not be approved.
- Reason
- Additional documentation was required.
Contact the hospital TPA Desk
End to end
One connected workflow from authorization to claim.
The workspace
One view for every payer case.
Give the Corporate & TPA Desk visibility across authorizations, documents, queries and claims without losing the context of the patient case.
| Case | Patient | Payer | Stage | Status |
|---|---|---|---|---|
| #10482 | A. Sharma | ABC | Authorization | Review |
| #10491 | R. Kumar | XYZ | Documents | Pending |
| #10503 | S. Patel | ABC | Query | Action |
| #10511 | N. Rao | DEF | Claim | Processed |
AI & voice
Ask the desk what needs attention.
Use natural language or voice to quickly understand authorization, document, query and claim status.
Voice input “Which pre-authorizations are waiting for documents?”
AI understands
8 authorization cases are waiting for documents.
- 3 require clinical reports
- 3 require estimates
- 2 require supporting documents
Outcomes
Keep every payer case moving.
01
Know what is pending
See which authorizations, documents, queries and claims need attention.
02
Know what is missing
Identify required information before it becomes another follow-up.
03
Keep the case connected
Keep documents, queries, decisions and claim activity linked to the patient case.
04
Keep patients informed
Send configured status updates when relevant payer or claim information changes.
Questions
Corporate & TPA, answered plainly.
What is a Corporate & TPA Desk in a hospital?
A Corporate & TPA Desk manages insurance, corporate and third-party administrator requirements related to patient care, including pre-authorization, documentation, payer queries and claims.
What does a hospital TPA Desk do?
A hospital TPA Desk handles authorization requests, collects required documents, responds to payer queries, tracks approval status and coordinates claim-related activities.
What is hospital pre-authorization?
Pre-authorization is the process of obtaining approval from an insurer or TPA for eligible treatment before the claim proceeds through the applicable cashless process.
Why do hospital pre-authorizations get delayed?
Pre-authorizations can be delayed when required medical information, documents, estimates or clarifications are incomplete or when additional information is requested by the payer.
How can hospitals manage missing documents for TPA approval?
Hospitals can use a document checklist to identify missing information, notify the responsible department, track document collection and update the authorization case once the required documents are available.
How can hospitals manage payer queries?
Hospitals can connect each payer query to the relevant patient case, assign it to the appropriate team, track the response and maintain the query status until it is resolved.
Can hospitals notify patients about insurance status?
Yes. Hospitals can configure patient notifications for relevant insurance or claim status updates, such as approval, rejection or a request for additional information.
What happens when an insurance claim is rejected?
When a claim is rejected, the hospital can record the rejection status and available reason, review the case and communicate the relevant information to the patient or responsible team.
How can hospitals track insurance claims?
Hospitals can track claims through stages such as submitted, under review, query raised, response submitted, approved, rejected or payment received, depending on the payer workflow.
What is the difference between pre-authorization and a claim?
Pre-authorization is the approval process associated with planned or eligible treatment, while a claim is the subsequent request for payment based on the actual treatment and applicable expenses.
How can Wisemelon help a hospital TPA Desk?
Wisemelon can connect authorization requests, document requirements, payer queries, claim status, responsible teams and configured patient communications into one operational workflow.
Hospital Operations
Bring Corporate & TPA operations into one connected workflow.
Give your hospital team visibility across authorizations, documents, payer queries and claims — while keeping the patient case connected.
- Authorization
- Documents
- Payer queries
- Claims
- Patient updates