Module group 12

TPA / Insurance Claims

L.K. Monu Borkala, Founder, OneCity Technologies · Published May 2026 · Last reviewed 14 July 2026

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.

TPA / Insurance Claims workflow in OneCity ERP

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.

Every OneCity module ties into the same shared patient record and compliance tracking, not a separate silo. For how this fits your broader accreditation planning, see our guide to NABH accreditation software. If you are still working out rollout timing, our guide to realistic ERP implementation timelines covers how modules like this one typically get sequenced. Pricing for this module is included from the Starter tier upward — see the full pricing breakdown, or the complete module list for how it fits alongside everything else.

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Frequently asked questions

Does it support PMJAY?

Yes, PMJAY claim data is captured alongside private TPA and CGHS/ECHS.