Healthcare
Reconciliation for hospitals, clinics, and diagnostic chains
Reconciliation in Healthcare
Healthcare organisations in India process payments through insurance TPAs, government schemes (Ayushman Bharat, CGHS), platform aggregators, and direct patient billing — each with different payment cycles, commission structures, and TDS deductions. A single hospital may process 500–5,000 insurance claims per month with settlements arriving in batches 15–45 days after discharge. Manual reconciliation of these multi-source, multi-deduction flows creates a chronic backlog that distorts revenue recognition and delays collections.
Where reconciliation breaks down
These are the structural problems that generic tools cannot solve for Healthcare businesses.
TPA and insurance settlement lag
Reimbursements from TPAs arrive 15–45 days after billing, aggregated across hundreds of claims, with deductions for co-pay shortfalls, disallowances, and TDS. Matching batch receipts to individual claim records requires structured disaggregation logic.
TDS on insurance payouts
TDS under Section 194J is deducted on professional services; TDS under Section 194C applies on contract payments. Healthcare businesses routinely receive settlement amounts net of TDS with no clear breakdown per claim — creating mismatches in Form 26AS reconciliation.
Government scheme reconciliation
Ayushman Bharat and CGHS payments arrive with scheme-specific deduction codes and approval references that do not map 1:1 to hospital billing systems. Reconciling approved vs billed amounts requires rule-based variance classification.
Diagnostic aggregator settlements
Platforms like Practo, 1mg, and PharmEasy disburse weekly settlements with platform fees and TDS pre-deducted. Each aggregator uses a different settlement format — standardising ingestion is a precondition for any reconciliation.
How TransactIG solves this
TransactIG is built by Terra Insight with healthcare-specific configuration, not generic matching logic.
TPA settlement matching
TransactIG ingests TPA settlement files and matches batch credits against individual claim records using patient ID, claim number, and approved amount — tolerating TDS deductions and partial payments.
Automated 26AS reconciliation
TDS certificates are matched against deductions on settlement files, with mismatches classified by section (194J vs 194C) and flagged for follow-up before filing.
Government scheme preset
The Ayushman Bharat and CGHS configuration preset maps scheme-specific deduction codes to variance categories, reducing unmatched items by over 80% compared to generic matching.
Reconciliation patterns
Configuration presets
No custom development
These presets are included with every Healthcare deployment of TransactIG. Go live in 2–4 weeks.
Frequently asked questions
How does TransactIG handle TPA files in different formats?
TransactIG supports configurable ingestion templates for major TPA formats including Excel, CSV, and proprietary portal exports. New formats can be mapped using the no-code field mapping interface without development work.
Can TransactIG reconcile Ayushman Bharat scheme payments?
Yes. The PM-JAY/AB preset maps scheme approval codes, deduction categories, and claim identifiers to match government disbursements against hospital billing records.
What happens when a TPA remits less than the approved amount?
TransactIG classifies the shortfall as a defined variance type (disallowance, co-pay, or unidentified) and flags it for review with the original claim reference — allowing targeted follow-up with the TPA.
Is patient data stored in TransactIG?
TransactIG processes financial transaction records (claim IDs, amounts, dates) — not clinical or patient health data. Data is hosted on AWS Mumbai and never leaves Indian jurisdiction.
Ready to automate Healthcare reconciliation?
Terra Insight will walk you through a live TransactIG demo using healthcare transaction data — matching patterns, variance taxonomy, and ERP integration.