Final bill · In-patient
For TPA desksHealth insurance claims, checked before they go out
Find the deduction before the insurer does.
Claimly reads the hospital bill, discharge summary, reports, pharmacy bills and the patient’s policy. It itemises every charge, checks each one against the policy, lists what is missing and pre-fills the claim form. Your staff review it and submit it. Every flag comes with a reason in plain language.
- Every linechecked against the policy
- Plain reasonsfor every flag
- Your staffreview and submit
Reads
- Hospital final bill
- Discharge summary
- Investigation reports
- Pharmacy bills
- Pre-auth letter
- Policy and e-card
- ID and KYC
Why desks lose money on claims
Most deductions are known before the file leaves the desk.
A missing page means a query
One unsigned form or a missing pharmacy bill, and the claim comes back days later. The patient is waiting, and so is your money.
Claimly lists every missing document before anything is submitted.
Room rent pulls down the whole bill
A room above the policy’s limit can reduce linked charges too, not only the room. Patients hear about it at discharge and feel cheated.
Claimly estimates it at the line level, so you can tell the family early.
Every policy reads differently
Co-pay, sub-limits, waiting periods, non-payable items. Checking a long bill against a long policy by hand is slow, careful work, and one missed clause costs money.
Claimly reads both and shows each finding next to the line it affects.
How it works
Six steps. The last one is always your staff.
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01 · Upload
Upload the documents
Scans, photos or PDFs of the bill, discharge summary, reports, pharmacy bills and the policy or e-card.
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02 · Read
Read and itemise
Every charge is sorted into room rent, procedure, pharmacy, consumables and investigations, with dates and amounts.
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03 · Check
Check against the policy
Room-rent limit, co-pay, sub-limits, non-payable items and waiting periods, read from the patient’s own policy.
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04 · Flag
Flags and missing documents
Each flag says what the issue is, why it matters and what would fix it. Missing documents are listed by name.
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05 · Pre-fill
Pre-fill the claim form
The cashless or reimbursement form is filled from the documents. Fields that need a human eye are marked.
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06 · Your staff
Staff review and submit
Your team fixes what they can, confirms the form and submits it on the insurer or TPA portal, as they do today.
What it checks
The checks your best billing person does, on every file.
Rules come from the patient’s own policy document, not from a generic list. The worked examples below use a fictional sample policy.
Room rent and proportionate deduction
Many policies cap the room rent per day. When the room taken costs more, some policies also reduce charges linked to the room category, such as doctor fees and OT charges, in the same ratio. Claimly works out both, line by line.
Worked example · sample policy
Room limit in policy₹5,000 / day
Room taken₹7,500 / day
Ratio applied to linked charges5,000 / 7,500 = 66.7%
Room rent above policy limit · proportionate deduction likely. Surgeon and OT charges of ₹70,000 may be paid at about ₹46,667. Tell the family before discharge.
Co-pay
Some policies ask the insured to pay a fixed share of every admissible claim, often by age, zone or plan. Claimly reads the co-pay clause and applies it after the other deductions, so the estimate is realistic.
Worked example · sample policy
Admissible after other checks₹82,400
Co-pay in policy10%
Patient share₹8,240
10% co-pay applies to this policy. Collect ₹8,240 from the patient at discharge or explain it on the estimate.
Sub-limits
Certain procedures, such as cataract surgery, or categories like ambulance, may have their own cap regardless of the sum insured. Claimly matches the procedure to the policy’s sub-limit table.
Worked example · sample policy
ProcedureCataract, one eye
Package billed₹52,000
Sub-limit in policy₹40,000 per eye
Cataract sub-limit applies. ₹12,000 above the cap is likely to be borne by the patient.
Non-payable items
Gloves, masks, admission kits, toiletries and similar items are commonly excluded. Claimly checks consumables against the non-payable list in the policy and marks each item it finds.
Worked example · sample policy
Admission kit₹950
Gloves and masks₹1,120
Nebuliser kit₹280
Listed as non-payable in this policy. ₹2,350 is likely to be deducted. Bill these to the patient directly.
Waiting periods
Some conditions and pre-existing diseases are covered only after a waiting period from the policy start date. Claimly compares the diagnosis and the admission date with the policy’s waiting-period clauses.
Worked example · sample policy
DiagnosisInguinal hernia
Policy in force since14 months
Waiting period for hernia24 months
Waiting period may not be complete. Check for earlier continuous cover (portability) before submitting.
Document checklist
Cashless and reimbursement claims need different papers, and accident cases need more. Claimly keeps a checklist for each claim type and ticks off what it has actually read.
Reimbursement · sample checklist
Discharge summary
Final bill with break-up
Investigation reports
Pharmacy bill with prescription, 2 of 3
Claim form signed by patient
Staff stay in control
Claimly suggests. Your staff decide.
Claimly is a tool for your desk. It is not an insurer, not a TPA, and it does not approve, reject or submit anything.
Claimly
Reads, checks, explains
- Itemises the bill and reads the policy
- Flags likely deductions with reasons
- Lists missing documents
- Pre-fills the form for review
Your staff
Review, fix, submit
- Accept or dismiss every flag
- Confirm marked fields on the form
- Collect missing papers
- Submit on the insurer or TPA portal
Insurer or TPA
Makes the decision
- Approves, queries or settles the claim
- Applies its own reading of the policy
- Claimly’s estimate never binds it
Every estimate in Claimly is labelled “estimate, not the insurer’s decision”. When a flag is uncertain, it says so.
Privacy
Health records, handled like health records.
- DPDP Act 2023. Patient data is processed for the claim, with the consent your hospital already takes, and kept only as long as the claim needs it.
- Desk team only. Access is limited to named staff on your claims desk. No shared logins.
- Audit log. Every view, edit, flag decision and export is recorded with the person and the time.
- Your data stays yours. It is not used to train models for anyone else, and it is deleted on request.
- 10:02Priya (TPA desk) uploaded 7 documents
- 10:04Claimly itemised 18 lines, raised 3 flags
- 10:11Priya (TPA desk) accepted flag “Room rent above limit”
- 10:15Priya (TPA desk) confirmed 4 form fields
- 10:31Suresh (Billing) viewed estimate
- 10:40Priya (TPA desk) marked ready to submit
The console
One queue for every open claim.
See which files are waiting on documents, which are checked and which are ready to submit. Open a claim to read every flag, confirm the form and answer insurer queries.
Open the console demoDocuments pending
3Checked
3Query raised
2Venkata R.₹1,27,210Checked · 3 flags
Farzana B.₹58,400Checked · 2 flags
Srinivas K.₹1,41,6502 documents missing
Lalitha M.₹84,300Query raised
Sample data · fictional hospital and patients
Pricing
Launch pricing · first 10 clients
One desk, one monthly price.
We set Claimly up with your team, on your claim types, and stay with you through the pilot. The AI and hosting costs are included in the plan.
Desk
For a hospital or nursing home claims desk
₹19,999 / month
Up to 300 claims a month
- Bill itemising and policy checks
- Plain-language flags and missing-document lists
- Pre-filled cashless and reimbursement forms
- Query-response helper
- Access for your desk team, with audit log
Additional claims
When a busy month goes past 300
₹99 / claim
Billed only for claims above the plan
- Same checks, same console
- No change of plan needed
Broker / TPA
Brokers, TPAs and corporate HR teams handling many hospitals or employees
Talk to us
Priced on volume and set-up
- Multiple teams and branches
- Claim types you handle most
- Reporting across clients
FAQ
Questions claims desks ask.
No. Claimly prepares the file and the form. Your staff review everything and submit on the insurer or TPA portal, the same way they do now.
No. It is an estimate based on how Claimly reads the bill and the policy. The insurer or TPA makes the decision and may read the policy differently. The estimate helps you spot likely deductions early and talk to the patient before discharge.
No. Claimly is a desk tool used by your staff. It has no tie-up with any insurer or TPA and does not act on their behalf.
It reads the policy schedule and wording you upload, whichever insurer issued it. During the pilot we test it on the claim types and policies your desk sees most, and tell you plainly where it is not reliable yet.
Clear phone photos and scans work. When a line cannot be read with confidence, Claimly marks it for a person to check instead of guessing.
Data is handled as the DPDP Act 2023 requires: used only for the claim, visible only to your desk team, logged on every access and deleted when you ask.
Usually two to three weeks: we set up your desk, load your common claim types and run real files side by side with your team before you rely on it.
Send us one old claim. We’ll show you what Claimly finds.
Message us on WhatsApp. We’ll run a past claim file through Claimly with you, with patient details removed, and walk your desk through every flag.
Talk to us on WhatsApp