The challenge
A 4-hospital multi-specialty network running on a Plus91 EMR was bleeding revenue on cashless insurance claims. Pre-authorisation packets were assembled manually by ward staff — discharge summary, ICD-10 codes, investigation reports, doctor notes — and faxed to TPAs like Paramount, MediAssist and Health India. Median turnaround was 38 hours. Patients sat in beds waiting for approval. 31% of packets bounced for missing fields and had to be reworked.
How we deployed
- Built an AI front-line routing agent on the main number that triages caller intent across 14 specialties and 4 locations.
- Deployed a document-extraction pipeline that reads handwritten doctor notes, lab PDFs and discharge summaries into a structured pre-auth packet.
- Auto-validated each packet against TPA-specific field rules before submission.
- Surfaced rejected packets in a single reviewer dashboard with the exact missing field flagged.
- Pushed status pings to ward staff via Slack the moment a TPA responded.
- Logged every packet and TPA response into the Plus91 EMR for audit.
What changed
- Pre-auth turnaround fell from 38 hours to 4.2 hours median across all 4 hospitals.
- TPA first-pass rejection rate dropped 61% inside 6 weeks.
- Inbound call routing landed on the right specialist desk 96.4% of the time.
- Bed-day waste from approval delays cut by an estimated 220 days per quarter.
- Patient satisfaction on the discharge survey climbed 18 points.
"We were not losing claims — we were losing days. Patients sitting in beds is the most expensive part of healthcare. That number collapsed."
— CFO · 4-hospital network