Fewer denials. Faster settlements.Every rupee collected.
AyyanRCM checks insurance and scheme eligibility at admission, manages pre-authorisations, builds complete claim files, uses AI to catch common denial reasons before submission and tracks every claim until the money is in your bank.
Or try it with 50 claims free, no card needed.
APPROVED
Built for hospitals that bill insurers, TPAs and government schemes every day.
A billing office where every file is in its place.
Seven desks, one claim record. Each desk picks up the case where the last one left it, with the documents, approvals and notes already attached.
Patient Intake
Register patients with their insurer, TPA or scheme details, confirm the policy at the admission counter and show room-rent limits and the expected patient share upfront.
- Policy and member verification. Capture policy number, member ID, TPA card and corporate tie-up details on one registration screen, with the policy period and sum insured confirmed before admission..
- Room-rent eligibility. Room category limits from the policy are shown against your own tariff, so the counter can explain proportionate deductions before the patient picks a room..
- Scheme beneficiary checks. Record beneficiary ID and family details for government schemes and see whether the planned treatment falls under a package your hospital is empanelled for..
Pre-Auth Desk
Build cashless requests with the treating doctor's notes, investigations and itemised estimates, send them to the insurer or TPA, and track queries, enhancements and approvals until discharge.
- Request built from clinical notes. Provisional diagnosis, clinical findings, duration of ailment and line of treatment are pulled into the request form from the doctor's notes..
- Itemised estimates. Estimates are built from your tariff and surgical packages, split into room, procedure, implants, pharmacy and investigations..
- Query inbox with timers. Every insurer and TPA query lands in one inbox with the time it arrived and how long the desk has to answer before the case goes cold..
| Request | Patient | Treatment | Amount | Status |
|---|---|---|---|---|
| PA-7731 | R. Venkatesh | PTCA, single stent | ₹2,10,000 | Approved |
| PA-7728 | S. Fatima | Lap cholecystectomy | ₹85,000 | Query 2h left |
| PA-7724 | K. Raghav | Enhancement, day 6 | ₹40,000 | Sent |
| PA-7719 | M. Joseph | TKR, right | ₹2,80,000 | Approved |
Claim Builder
Turn the final bill into a claim file with every required document attached, arranged to the insurer's or TPA's checklist and ready to submit the day the patient leaves.
- Payer-specific checklists. Each insurer, TPA and corporate payer has its own document list.
- Payable and non-payable split. The final bill is split into payable and non-payable items, so the patient's share is settled at the counter and not disputed weeks later..
- Implant and pharmacy invoices. Implant invoices are matched with sticker copies, batch numbers and the pre-auth approval, the most common gap in surgical claims..
AI Denial Predictor
Before a claim leaves the hospital, the AI Denial Predictor reads the bill, documents and approvals and flags the gaps most often behind queries, deductions and rejections. Your billing team decides what to fix.
- Missing documents. Compares the claim file with the payer's checklist and with what the bill implies.
- Coding gaps. Flags diagnoses written in the discharge summary without a code, and procedure codes that do not match the procedure approved in the pre-auth..
- Non-payable items. Highlights bill lines commonly treated as non-payable, such as gloves, admission kits and registration charges, so the patient share is right..
Scheme Claims
Manage packages, pre-authorisations and claims for the government health schemes your hospital is empanelled with, with a document checklist for every package and every stage.
- Package master. Package codes, rates and mandatory documents for each scheme you are empanelled with are kept in one master and updated when rates change..
- Beneficiary records. Beneficiary ID, family details and verification outcome are stored with the case, ready for the pre-auth and the claim..
- Pre-auth with package selection. Choose the package, attach the clinical notes and investigations it requires, and track the scheme pre-auth to approval..
Collections Tracker
See outstanding claims by payer and age, answer queries before they lapse, record settlements and deductions, and reconcile every payment with your bank receipts.
- Ageing by payer. Outstanding claims grouped by insurer, TPA and scheme in 0-30, 31-60, 61-90 and 90+ day buckets, with the oldest claims on top..
- Query timers. Post-submission queries show the days left to reply.
- Settlements and deductions. Record the settled amount, TDS and every deduction with its reason, straight from the settlement letter..
RCM Dashboard
Days in receivables, first-pass approval rate, denial and deduction reasons, and collections by insurer, TPA and scheme, for one hospital or every hospital in your group.
- Days in receivables. Average days from discharge to payment, overall and for every payer, so you know which TPA to call first..
- First-pass approval rate. The share of claims settled without a query, by payer and department.
- Deduction analysis. Deductions grouped by reason, payer and department, showing where money is lost and which fixes will return the most..
The usual reasons, caught at the desk.
Most queries and deductions trace back to a handful of gaps. Each one has a desk in AyyanRCM where it gets caught.
Missing documents
An implant on the bill with no sticker copy, or a billed test with no report attached.
Coding gaps
A diagnosis in the discharge summary with no ICD-10 code, or a procedure code that differs from the pre-auth.
Room-rent deductions
The patient stayed above the eligible room category and every linked charge is cut proportionately.
Non-payable items
Gloves, admission kits and registration charges billed to the insurer and later deducted.
Bill above approval
The final bill crosses the approved amount and no enhancement was raised during the stay.
Date mismatches
Admission or discharge dates differ between the claim form, the bill and the discharge summary.
Lapsed queries
A post-submission query goes unanswered past its window and the claim is closed.
Waiting periods
The treatment falls under a waiting period or exclusion the counter never checked.
The AI points. Your billing team decides.
AyyanRCM supports billing and claims. It does not touch clinical decisions or medical records, and it does not help anyone game a claim.
How the AI Denial Predictor worksFlags, never edits
The AI Denial Predictor reads claim files and lists possible issues with reasons. It never changes a bill, a code or a medical record.
Your staff code and decide
ICD-10 and procedure codes are added or approved by your trained billing staff. Every fix or dismissal is recorded with a name and time.
Accurate claims only
Claims are submitted with documented, accurate information. AyyanRCM does not support inflating, padding or altering claims.
Patient data stays confidential
Health and insurance data is encrypted, visible only to authorised staff by role, and never sold or shared for advertising.
Four weeks from first call to first checked claim.
Your billing team keeps working through the change. We set up the desks around how your hospital already bills.
Masters and payers
Tariffs, packages, payer list, TPA tie-ups and scheme empanelments are loaded.
HIS connection
Patient, bill and discharge data starts flowing from your HIS, or from file uploads if you prefer.
Desk training
Front office, pre-auth, billing and accounts teams are trained on their own desks with live cases.
Live with review
Every claim goes through the AI review before submission and the dashboard starts tracking.
What billing heads ask us first.
Anything else, ask the team directly and we will answer with your hospital in mind.
Contact teamNo. It makes them faster and more accurate. Your team still registers patients, raises pre-auths, codes discharge summaries and answers queries. AyyanRCM keeps the documents, checklists and timers in one place and points out gaps before a claim goes out.
Yes. Patient registration, bills and discharge summaries can be pulled from your HIS through an integration or scheduled file exports. If your HIS has no integration option, the team can upload bills and documents directly.
Yes. Scheme Claims keeps the package master, beneficiary details, stage-wise document checklists and claim status for each scheme you are empanelled with, separately from insurer and TPA claims.
No. The AI Denial Predictor only flags possible issues with a reason and the document it refers to. Billing staff decide what to fix. Coding is done or approved by your trained staff, and nothing in a medical record is altered.
Patient health and insurance data is encrypted in transit and at rest, access is limited by role to authorised staff, every view and change is logged, and the data is never sold.
Most single hospitals go live in about four weeks: masters and payers in week one, HIS connection in week two, desk training in week three and live claims with AI review in week four. Groups are rolled out hospital by hospital.
Every folder stamped settled before you lock the door.
Show us last month's claims. We will run them through AyyanRCM with your team and show you which ones would have been flagged, and how much would have come back.