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AR-0412 Fathima Begum

Cataract balance · overdue 21 days

₹6,200

AR-0418 Padma Sree

Delivery package balance

₹3,000

Flip Simulate link failure in the header, then collect a payment and file a claim — the payment succeeds on this counter, the claim waits for the payer.

From the ward — B. Srinu's discharge · 67M · post-op knee (TKR)

Two things need Anasuya: the final bill, and the PM-JAY claim packet

✦ 2 drafts awaiting you

✦ Final bill INV-2026-0848 — reconciled against 34 charted events ₹950 of charted-but-unbilled care caught Review in Bill Composer →

✦ PM-JAY claim packet — HBP-2.7.1, total knee replacement ₹1,45,000 · filing window opens on discharge, 19 Jul Open Claims & Pre-auth →

Dressing change, ₹350 — recorded in the nursing notes on 16 Jul, never posted to the bill.
One physiotherapy session, ₹600 — the physio log has 3 sessions on 16–18 Jul; the bill carried 2.
Both were found by matching the chart against the bill line by line, which is the only way a charted-but-unbilled item ever surfaces.
The PM-JAY window is 3 days from discharge and it is forfeited, not merely late — so the packet is assembled before the bill is even approved.

Sources: nursing record 16 Jul · physiotherapy log 16–18 Jul · IPD chart (34 events) · PM-JAY HBP-2.7.1 package master

HOS drafted both and filed neither. The invoice prints when Anasuya approves it in the Composer; the claim goes to the TMS portal when she files it in Claims.

Today's bills

9 bills

Time	Patient	Type	Amount	Status	Mode
09:12 AM	Lakshmi Devi Dr. K. Ramesh · OPD consult	OPD	₹850	Paid	UPI
09:47 AM	Venkatesh Naidu Dr. K. Ramesh · OPD consult	OPD	₹600	Paid	Cash
10:05 AM	Mohd. Irfan Rx · dispensed by Ravi Teja	Pharmacy	₹1,240	Paid	UPI
10:38 AM	Padma Sree Dr. Sunitha Rao · ANC + scan	OPD	₹2,450	Paid	UPI
11:12 AM	Lakshmi Devi Rx · Metformin + Telmisartan refill	Pharmacy	₹2,090	Partial ₹800 due	Cash
11:55 AM	G. Ramulu Advance · admission, Bed 12	IPD	₹80,000	Paid	UPI
12:20 PM	B. Srinu IPD final bill · PM-JAY · discharge 19 Jul	IPD	₹4,850	Pending Draft · ₹15,150 refund due	—
01:15 PM	Mohd. Irfan Lab · CBC, LFT — Prasad	Lab	₹740	Paid	Cash
02:30 PM	Venkatesh Naidu Dr. K. Ramesh · follow-up	OPD	₹500	Paid	UPI

Collected today

₹87,670

UPI ₹85,040 · Cash ₹2,630

Outstanding ₹63,000 · see Outstanding (AR) tab for aged accounts

Final bill — B. Srinu · 67M · post-op knee (TKR)

Bill no. INV-2026-0848 · draft

Discharge tomorrow · 19 Jul

UHID SVH-2019-04412 ABHA 91-1234-5678-9012 Bed General · GM-05 Admitted 15 Jul 2026 → Discharge 19 Jul 2026 Payer PM-JAY · cashless HBP-2.7.1 Surgeon Dr. P. Anil Kumar (Orthopedics)

B. Srinu is cleared for discharge tomorrow, 19 Jul. 34 clinical events were charted across his 4-day stay — room nights, nursing shifts, the OT record, physio log, lab orders and pharmacy issues. The Billing Agent can draft every line item from those events so nothing is missed. He is a PM-JAY cashless beneficiary, so the package — not the patient — pays for covered care.

✦ 11 line items drafted from 34 clinical events — 2 unbilled items caught, 2 outside the package Draft — awaiting approval

Assembled from the IPD chart: room nights, nursing shifts, OT record, physio log, lab orders and pharmacy issues. Every line links to its source event — verify, then approve. Package-covered care is separated from what falls outside HBP-2.7.1.

Line item	Qty	Amount
Room — General ward · GM-05 15–19 Jul · from event: bed allocation Bed allocation · GM-05 Allocated 15 Jul, 09:40 AM by front-desk (Reception). General male ward, Orthopedics unit. Closes on discharge, 19 Jul. The HBP-2.7.1 package entitles a semi-private bed; a general-ward bed was allocated. Recorded against the claim — the package rate is fixed either way.	×4 days	₹6,000
Nursing charges Nurse Mary Grace, shift log · from event	×4 days	₹2,000
Surgeon fee — Total Knee Replacement OT record 15 Jul, Dr. P. Anil Kumar · from event	×1	₹35,000
OT charges OT-2 · 15 Jul, 2h 40m · from event	×1	₹18,000
Anesthesia — spinal OT record 15 Jul · from event	×1	₹8,000
Physiotherapy sessions ✦ 17 Jul session was unbilled 16–18 Jul, physio log · from event	×3	₹1,800
Dressing change & consumables ✦ was unbilled 16 Jul, nursing record · from event	×1	₹350
Lab — CBC, RFT Ordered 15 & 17 Jul, lab tech Prasad · from event	×2	₹1,540
Pharmacy — 12 items Incl. Inj. Ceftriaxone 1g, Tab. Pantoprazole 40mg · GST 12% incl. · from event	12 items	₹9,510
Care delivered — covered by the package		₹82,200
PM-JAY HBP-2.7.1 claimed from the scheme cashless · fixed package rate		₹1,45,000
Outside the package — patient payable
Attendant bed 15–19 Jul, ward register · from event	×4 nights	₹2,000
Take-home medicines Discharge Rx, pharmacy counter · GST 12% incl. · from event	×1	₹2,850
Patient payable		₹4,850
Advance collected Advance · 09 Jul, see Advances & Packages		−₹20,000
Refund due to the patient		₹15,150

Professional fees & room charges — GST exempt (healthcare services). Take-home medicines carry 12% GST, shown on the tax invoice once approved.

✦ Flagged — patient-payable amounts recorded on a cashless PM-JAY admission Reference alert · your call

The payer rule captured at registration for HBP-2.7.1 records ₹0 patient-payable and ₹0 advance to collect — package care is not billable to a beneficiary. Against that rule, two things are recorded on this admission:

A ₹20,000 surgery advance was collected on 09 Jul, before the PM-JAY package was applied to this admission.
₹4,850 of items are recorded outside the package — attendant bed ₹2,000 and take-home medicines ₹2,850.

Netted against the advance, ₹15,150 is refundable to the patient. HOS has not moved money, adjusted the advance or waived a line. Anasuya confirms before anything is collected or refunded.

Sources: PM-JAY payer rule at registration (Reception) · advance receipt 09 Jul · ward register 15–19 Jul · discharge Rx · scheme master HBP-2.7.1

Nothing is collected or refunded without Anasuya.

Nothing prints until Anasuya approves.

Deposits & advances

5 open

Patient	Amount	Date	Purpose	Status
G. Ramulu Bed 12 · Orthopedics	₹80,000	18 Jul 2026	Admission advance	Held
B. Srinu TKR package, pre-op	₹20,000	09 Jul 2026	Surgery advance	Applied to INV-2026-0848 draft
Padma Sree 28w, expected Aug	₹15,000	10 Jul 2026	Delivery package advance	Held
K. Bhaskar Rao Day-care endoscopy	₹10,000	16 Jul 2026	Procedure advance	Applied to INV-2026-0839
Fathima Begum Cataract, right eye	₹8,000	13 Jul 2026	Phaco package advance	Held

Advances are receipts, not GST tax invoices — they move to the GST Invoices register only once applied to a final bill.

Package pricing

All-inclusive

Total Knee Replacement (TKR)

Semi-private room ×5 days, surgeon fee, OT, implant, spinal anesthesia, physio ×3, standard medicines

₹1,45,000

Normal delivery

Semi-private room ×2 days, OBG consultant, nursing, delivery kit, newborn check

₹35,000

Caesarean delivery

Semi-private room ×3 days, OBG consultant + anesthetist, OT, nursing, newborn check

₹52,000

Cataract (phaco)

Day-care OT, monofocal IOL lens, post-op review ×2

₹28,000 / eye

Laparoscopic cholecystectomy

Semi-private room ×2 days, surgeon + anesthetist, OT, standard medicines

₹48,000

Generated invoice register

7 invoices · today

Invoice no.	Patient	Amount	GST amount	Date
INV-2026-0841	Lakshmi Devi	₹850	₹0 exempt	18 Jul 2026
INV-2026-0842	Venkatesh Naidu	₹600	₹0 exempt	18 Jul 2026
INV-2026-0843	Mohd. Irfan · pharmacy	₹1,240	₹133 12%	18 Jul 2026
INV-2026-0844	Padma Sree	₹2,450	₹0 exempt	18 Jul 2026
INV-2026-0845	Lakshmi Devi · pharmacy	₹2,090	₹224 12%	18 Jul 2026
INV-2026-0846	Mohd. Irfan · lab	₹740	₹0 exempt	18 Jul 2026
INV-2026-0847	Venkatesh Naidu · follow-up	₹500	₹0 exempt	18 Jul 2026

INV-2026-0848 (B. Srinu, ₹4,850 patient-payable) is still a draft in the Bill Composer tab — it will appear here automatically once approved.

In adjudication

₹8.42L

31 claims · 4 payers

Pre-auth pending

6

1 inside the last hour

PM-JAY 3-day clock

1

1 due tomorrow · B. Srinu's opens 19 Jul

Denied this month

₹1.14L

9 claims · 7 appealable

Avg days to payment

37

▼ from 52

⏱ Pre-auth assembled — S. Ramulamma, ICU-01 Draft — awaiting approval IRDAI clock · 41 min left

Star Health cashless pre-auth for septic shock, ICU admission. IRDAI requires the insurer to decide a pre-authorisation within 1 hour — but the clock only starts when a complete request lands. Two of the last four were rejected as incomplete and restarted the clock.

The 3-hour limit people usually quote is a different clock on a different event — final authorisation at discharge, where the insurer bears the extra cost of any delay beyond it. Both come from the IRDAI Master Circular of 29 May 2024, and conflating them is why hospitals chase the wrong deadline.

HOS assembled all 7 required documents from the record: admission note, vitals chart, ICU justification, provisional diagnosis with ICD-10 (A41.9), treatment plan, estimate (₹1,42,000), and the policy/ID pair. Nothing is missing, so the clock will not restart.

Assembled from 34 chart events · ICD-10 coded by the AI · estimate priced from your tariff master

Claims in flight

Every scheme's own clock, in one place — PM-JAY forfeits after 3 days from discharge. Filing now checks each claim against this hospital's own history with that payer, and against this hospital's own pharmacy and dosing records, before it goes out.

NHCX · FHIR e-claims

Patient	Scheme / payer	Package	Amount	Clock	Status
B. Srinu 67M · discharge 19 Jul	PM-JAY TMS portal	Total knee replacement HBP-2.7.1	₹1,45,000	Opens 19 Jul 3-day window runs from discharge	Packet assembled
T. Saroja 58F · discharged 16 Jul	PM-JAY TMS portal	Cholecystectomy HBP-6.2.3	₹42,000	1 day left	Ready to file
S. Ramulamma 64F · ICU, in-patient	Star Health cashless TPA	Septic shock — ICU ICD-10 A41.9	₹1,42,000	41 min	Pre-auth assembled
A. Bhaskar Rao 55M · ICU Day 1	CGHS	Acute MI — thrombolysis	₹98,000	—	In adjudication
N. Someswara Rao 58M · general surgery	Star Health cashless TPA	Right inguinal hernia repair ICD-10 K40.90	₹56,000	—	Awaiting filing
⚠ Filing risk — missing itemized pharmacy bill 3 of your last 5 Star Health submissions this quarter were queried or denied for a missing itemized pharmacy bill — this claim doesn't have one attached either. Source: this hospital's own last 5 Star Health submissions, Apr–Jul 2026 — HOS never shares claims data across hospitals, so this pattern comes only from your own history, not a cross-hospital dataset.
P. Venkata Ramana 59M · general medicine	Star Health cashless TPA	Community-acquired pneumonia — IV antibiotics ICD-10 J18.9	₹38,000	—	Awaiting filing
⚠ Filing check — 2 things worth a look before this goes to Star Health Missing traceability code: 2 of 6 billed pharmacy lines have no batch/traceability code captured — Inj. Piperacillin-Tazobactam 4.5g and Inj. Pantoprazole 40mg. More payers are moving toward requiring one on every pharmacy line; today it is more often a query than an outright denial, but it's cheaper to attach it now than to answer for it later. Quantity outside the usual range: 8 vials of Piperacillin-Tazobactam charted against a 2-day antibiotic course (started 17 Jul, day 3 of the stay) works out to 4/day — your own pharmacy master lists 2–3/day as typical for this indication. Source: this bill's own pharmacy line items · this hospital's pharmacy dosing master · ICD-10 J18.9. Internal consistency only — HOS does not know whether Star Health will query either line, and this is not medical advice about the dose itself.
Padma Sree 28F · antenatal	ESIC	Antenatal package	₹18,500	—	Paid 17 Jul	Settled in 21 days

✦ Denial appeal drafted — 7 of 9 denials are appealable Draft — awaiting approval

₹1,14,000 was denied this month. HOS read every rejection reason against the record and found 7 that contradict what the chart shows — worth ₹86,400. The most valuable: Star Health denied K. Narayana's 2-day ICU stay as "not medically necessary", but the chart shows lactate 4.1 and MAP 58 at admission, which meets their own published ICU criteria.

Appeals are drafted with the specific chart evidence quoted and the payer's own policy clause cited. 2 denials are genuinely correct — a duplicate submission and a lapsed policy — and HOS says so rather than appealing everything.

Nothing is auto-submitted · each appeal needs your signature · every draft cites its source events

Total outstanding

₹50,900

across 5 accounts

Over 30 days

₹40,900

2 accounts at risk

Reminders sent

4

this week, via WhatsApp

✦ Billing Agent drafted 2 reminders for accounts over 30 days overdue Draft — awaiting approval

"నమస్తే K. Bhaskar Rao గారు, మీ బిల్లు ₹12,400 బాకీ ఉంది — దయచేసి చెల్లించండి." and a similar Telugu-language message queued for Ravindra Reddy (₹28,500). Sent via WhatsApp once approved; auto-schedules the next follow-up at day 45 if unpaid.

Aging — who owes what

5 accounts

Patient	Amount due	Days overdue	Last reminder sent
Ravindra Reddy IPD balance, general ward	₹28,500	52 days	Call + WhatsApp · 02 Jul 2026
K. Bhaskar Rao Endoscopy, balance after advance	₹12,400	34 days	WhatsApp · 10 Jul 2026
Fathima Begum Cataract package, right eye balance	₹6,200	18 days	WhatsApp · 15 Jul 2026
Padma Sree Delivery package balance	₹3,000	8 days	WhatsApp · 12 Jul 2026
Lakshmi Devi Pharmacy balance, 11:12 AM bill	₹800	Not yet	Not sent yet