Panel & Insurance Management
The Panel & Insurance Management module in DOCare streamlines the entire process of handling corporate, panel, and insurance patient billing with accuracy and speed. It allows hospitals to maintain up-to-date agreements with multiple insurance providers, automate claim submission, and track the status of each claim in real-time. Patient eligibility and policy coverage can be verified instantly, reducing delays and rejections. Detailed analytics provide insights into outstanding amounts, approved claims, and pending dues per provider. With role-based access, your finance and billing teams can process insurance transactions securely while ensuring compliance with contractual terms. This module reduces manual errors, speeds up settlements, and maximizes insurance revenue recovery.
Panel-Wise Patient Insights
With DOCare, hospitals can instantly view the real-time count of active panel and insurance patients. Patient distribution is easily categorized by panel type, including corporate, insurance, and government schemes like Sehat Sahulat. Pending authorization requests are tracked per panel to avoid delays, while top-utilized panels can be identified by both patient volume and billing value. This empowers administrators to make data-driven decisions about panel partnerships and service strategies.
- Real-time count of active panel/insurance patients
- Patient distribution by panel type (corporate, insurance, govt schemes like Sehat Sahulat)
- Pending authorization requests per panel
- Top-utilized panels by patient volume and billing value
Authorization & Claim Tracking
Monitor the live status of insurance authorizations, including approvals, pending requests, and rejections, directly in DOCare. The system provides detailed statistics on claims submitted versus approved or rejected, along with average processing times per panel or insurer. Automated alerts for expiring panel agreements or missing documentation ensure compliance and reduce claim rejection risks. This helps streamline insurance workflows and ensures faster claim settlements.
- Live status of insurance authorizations (Approved / Pending / Rejected)
- Claims submission vs approval vs rejection stats
- Average processing time by panel or insurer
- Alerts for expiring panel agreements or pending documentation
Panel Billing & Settlement Overview
DOCare delivers a complete view of billing and settlement processes across all panels. Users can compare the total billed amount versus what’s approved and paid, while tracking claim settlement aging across 0–30, 31–60, and 60+ days. Pending invoices are paired with follow-up logs for accountability, and outstanding balances per panel are monitored with turnaround time (TAT) metrics. This ensures timely follow-ups and better cash flow management.
- Total billed amount vs approved vs paid by panel
- Claim settlement aging by panel (0-30, 31-60, 60+ days)
- Pending invoices with follow-up logs
- Panel-wise outstanding balance and TAT (Turnaround Time) metrics
Contract & Rate Agreement Monitoring
Keep a centralized record of all active and inactive panel agreements along with their expiry dates in DOCare. The module compares negotiated service rates against actual applied rates to identify mismatches during billing. Automated notifications for upcoming contract renewals prevent lapses, while alerts for rate discrepancies ensure accurate and compliant billing. This safeguards revenue and maintains strong insurer relationships.
- List of active/inactive panel agreements with expiry dates
- Service-wise negotiated rates vs actual applied rates
- Alert for rate mismatches during billing
- Auto-notification for upcoming contract renewals
Financial & Revenue Analysis
Gain a clear understanding of your hospital’s revenue sources by comparing panel versus non-panel contributions. DOCare highlights each panel’s share in total revenue, identifies high-cost services frequently used under insurance, and provides root-cause analysis for rejected claims. This financial visibility enables better pricing, improved negotiations with panels, and maximized revenue recovery from insurance-covered services.
- Revenue share from panel vs non-panel patients
- contribution of each panel to overall hospital revenue
- High-cost service usage trends under insurance coverage
- Reports on rejected claims and root-cause analysis
Compliance & Document Verification
DOCare ensures every insurance case meets compliance requirements with real-time verification of CNICs, insurance cards, and referral documents. Missing document alerts and breach logs prevent claim disputes, while the system tracks upload statuses and expiry dates of policy documents. For medico-legal cases (MLCs) linked to insurance, alerts are triggered instantly to maintain legal and procedural accuracy.
- Real-time verification status of CNIC, insurance card, and referral documents
- Missing document alerts and compliance breach logs
- Upload status and expiry tracking of policy documents
- MLC (Medico-Legal Case) alerts linked with insurance cases
- Gain actionable insights from employee performance and incentive reports
Operational Efficiency KPIs
Track claims processed per panel on a daily or weekly basis, along with user-wise claim entry and processing statistics. DOCare’s auto-escalation triggers highlight delayed authorizations, while SLA breach alerts come with a detailed response log for accountability. This results in faster claim processing, reduced backlogs, and improved panel relationship management.
- Claims per panel processed per day/week
- User-wise claim entry and processing stats
- Auto-escalation triggers for delayed authorizations
- SLA breach alerts with response log tracking
Exportable Reports & Dashboard Views
Access comprehensive panel-wise billing, collection, and receivable summaries in DOCare’s intuitive dashboard. Interactive insurance TAT and rejection rate visualizations help you identify bottlenecks. Reports can be exported in Excel, PDF, or department-specific printable formats, with drill-down capabilities from overall metrics down to patient-level details. This makes financial reporting both actionable and audit-ready.
- Panel-wise billing, collection, and receivable summaries
- Insurance TAT and rejection rate dashboards
- Export in Excel, PDF, or department-specific printable formats
- Drill-down reports from overall metrics to patient-level details
Panel & Corporate Patient Management
Insurance Claim Processing
- Real-Time Claim Status Tracking Monitor claims as they move from submission to approval or rejection with live status updates.
- Bulk Claim Submission Process and submit multiple claims to insurance companies in batches for faster turnaround.
- lntegrated Document Management Attach supporting documents like prescriptions, investigation reports, and discharge summaries directly to claims.
Outstanding & Receivable Management
- Company-Wise Outstanding Reports View pending dues by insurance provider to prioritize follow-ups.
- Aging Analysis of Claims Track how long claims have been pending to identify delays and take corrective actions.
- Receivable Alerts & Notifications Receive alerts for overdue claims to speed up recovery and maintain cash flow.
Panel vs General Billing Analysis
- Revenue Comparison Reports Compare income generated from panel patients versus general patients for strategic decision-making.
- Service Utilization Insights Analyze which services are most frequently availed by panel patients to improve offerings.
- Profitability Tracking Assess cost-to-revenue ratios for each panel to identify high-value contracts.