Module group 12
TPA / Insurance Claims
The problem
Claims are tracked on spreadsheets; pre-auth and settlement slip through the cracks.
How OneCity handles it
Pre-authorisation, claim submission and settlement tracking for TPA, PMJAY, CGHS and ECHS, ready for NHCX exchange.
What's inside
Pre-Authorisation Cashless pre-auth requests and approvals.
Claim Submission & Settlement Submit, track and reconcile claims.
Insurance & TPA Processing Insurance claim lifecycle: pre-authorization, claim submission, tracking, settle → NHCX Claims Exchange National Health Claims Exchange: digital claim submission, adjudication tracking → PMJAY / CGHS / ECHS Government health scheme management: PMJAY package rates, CGHS/ECHS empanelment, → India compliance
- IRDAI
- PMJAY / NHA
- NHCX
Integrations
- Billing
- NHCX
- PMJAY
Vendor integrations run in stub mode — payloads generated to spec, live posting enabled per site after onboarding.
Questions
Does it support PMJAY?+
Yes, PMJAY claim data is captured alongside private TPA and CGHS/ECHS.
Related reading
External references
- PM-JAY official portal — Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana
See TPA / Insurance Claims on real data.
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