Claim workbench
Search by patient, IPD number, UHID, policy or payer claim number. Filter to what is open, queried or overdue.
NHCX-ready claim management
Every claim, from bill to bank.
Caresoft Claim Manager takes the final bill out of your hospital system, sends it to the TPA or insurer, and tracks it through pre-authorisation, adjudication, deduction and settlement — in one place, on one screen.
1,000+
Hospitals on Caresoft systems
June 2024
NHCX live, built by NHA with IRDAI
FHIR R4
Standard claim bundles
Line level
Deduction tracking
In short
Caresoft Claim Manager is health insurance claim management software for Indian hospitals. It connects a hospital information system to TPAs, insurers and government schemes through the National Health Claims Exchange (NHCX) and direct payer integrations, covering coverage eligibility, pre-authorisation, final claim submission, query handling, deduction tracking and settlement reconciliation.
The claim journey
Four stages. One screen.
A claim does not fail all at once. It fails at a stage, for a reason, on a line. So we track it that way.
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1
Eligibility
Check the policy is live and the balance is real before the patient is admitted, not after discharge.
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2
Pre-authorisation
Send the request with a structured bundle. Track approval, query and enhancement in one thread.
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3
Final claim
The final bill leaves your hospital system, becomes a FHIR bundle, and reaches the payer with every mandatory document attached.
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4
Settlement
Approved, deducted, paid. Reconciled against the UTR and posted back into your receivables.
What you get
Everything the TPA desk has been doing on paper.
Line-level deductions
Every disallowance recorded against the bill line and reason code it belongs to, so you can argue it or price it in.
Document checklist
Configure what each payer needs per stage. A claim cannot be sent until the mandatory set is attached.
Query management
Payer queries arrive with a due date and stay visible until they are answered.
Ageing and receivables
Outstanding value by age bucket, by payer, by department. The report your CFO asks for on the fifth.
Group-ready access
Three levels of control: group admin, hospital admin, and the executives who work claims.
Before and after
What actually changes.
A different portal, login and format for every payer
One submission, routed by the exchange or an adapter
Deductions noticed when the payment lands short
Deductions recorded per line, with the reason, as they happen
Discharge held while someone chases a pre-auth by phone
Pre-auth status visible on the case, with the query thread attached
Ageing worked out in a spreadsheet at month end
Ageing on the dashboard, live, by payer
Coverage
Connected where it counts.
Exchange, direct adapter, or assisted portal submission — routed per payer, so your receivables do not wait for the ecosystem to catch up.
Verified
The numbers, with their sources.
June 2024
NHCX went live and processed its first claim in June 2024, built by the National Health Authority in consultation with IRDAI under ABDM.
Source: National Health Authority · as of Jun 2024
₹500 / claim
Under the Digital Health Incentive Scheme, hospitals can receive ₹500 per claim or 10% of the claim amount, whichever is lower, for claims processed through NHCX.
Source: National Health Authority, Digital Health Incentive Scheme · as of Jun 2024
FHIR R4
NHCX uses the HL7 FHIR R4 standard for claim bundles, and routes messages without reading the encrypted clinical and financial payload.
Source: National Health Authority · as of Jun 2024
1,000+ hospitals
Caresoft Systems Private Limited serves over 1,000 hospitals across India and holds CMMI Level 5, ISO 27001 and PCI DSS certifications.
Source: Caresoft Systems · as of Jan 2026
Questions
What hospitals ask us first.
What is NHCX?
NHCX, the National Health Claims Exchange, is a digital gateway built by India's National Health Authority in consultation with IRDAI under the Ayushman Bharat Digital Mission. It went live in June 2024. It routes health insurance claims between hospitals, insurers and TPAs in a standard FHIR format, so a hospital submits once instead of working a separate portal for each payer. The exchange reads only the routing headers — the clinical and financial payload is encrypted end to end.
Do we need to be ABDM compliant before using NHCX?
Yes. A hospital needs a Health Facility Registry (HFR) identity before it can transact on the exchange, and the ABDM milestones sit behind that. If you are already on a Caresoft hospital system, most of that groundwork is shared with work you have done or are doing for ABDM.
What happens if our TPA is not live on NHCX yet?
The claim still goes. Caresoft Claim Manager routes by payer: the exchange where the payer is live, a direct API adapter where they have their own interface, and assisted portal submission where no interface exists. In the last case the system assembles the complete claim set and the outcome is recorded back against the case, so your reporting stays whole either way.
Is there any financial incentive for submitting claims digitally?
Under the Digital Health Incentive Scheme, hospitals can receive ₹500 per claim or 10% of the claim amount, whichever is lower, for claims processed through NHCX. The incentive is paid to the hospital. Scheme terms change, so confirm the current position with the National Health Authority before you build it into a business case.
Does this replace our hospital information system?
No. It sits alongside it. The final bill, patient and policy details come from your HIS; the claim status, approved amount and deductions go back to it. If you run Caresoft HIS the connection is built in. Other systems connect through the same push API.
How does deduction tracking actually work?
When a payer responds, the adjudication comes back per bill line, not just as a total. Each disallowance is stored against the line it hit, with the payer's reason code, and classified — room rent proportionate deduction, non-payable item, tariff excess, co-payment, sub-limit, documentation. You can then see which payer, which reason and which department is costing you the most over a period.
Insights
Written for the TPA desk.
Why TPAs deduct room rent proportionately, and what it costs you
The single most common deduction on an Indian cashless claim is not a rejected procedure. It is the room rent clause quietly reducing everything else on the bill.
NHCX explained for hospital billing teams
Not the policy version. What actually changes at the counter when your hospital connects to the exchange.
Nine reasons cashless claims get rejected, and how to stop each one
Most rejections are not clinical disputes. They are data problems created at registration and discovered at discharge.
See it against your own claims.
Send a bed count and two payer names. We will run the demo on a case that looks like yours.