🏥 Insurance & Benefits

Cashless OPD

Fully digital outpatient benefit administration from policy issuance to real-time authorization at provider networks. Zero paper, zero delays, zero leakage.

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✅ NHCX Integrated 🤖 AI Authorization 📱 Digital Card
Cashless OPD Agent · Auth Request
// Member visits provider network → cashlessopd.verify_member("card: CORP-EMP-4421") member: Priya Sharma employer: TechCorp India Pvt Ltd opd_balance: ₹8,400 remaining   // Pre-authorization check → cashlessopd.authorize() consultation: General Physician OPD amount: ₹600 policy_check: COVERED ✓ fraud_check: CLEAR ✓   → cashlessopd.settle() auth_code: OPD-AUTH-882941 status: approved ✓ elapsed: 1.1s
1.1sAverage authorization time
100%Digital zero paper
99%Fraud detection accuracy
40%Lower admin cost vs legacy OPD
Features

OPD benefits, completely
reimagined for the digital age

📱

Digital Member Cards

Issue virtual OPD benefit cards instantly via mobile app or SMS. Members present their QR code at any empanelled provider no physical card needed.

⚡

Real-Time Authorization

Providers request authorization at the point of care. AI checks policy terms, benefit balance, and fraud indicators approval in under 2 seconds.

🔍

AI Fraud Prevention

Pattern analysis flags duplicate visits, phantom bills, and network abuse in real time before payment is authorized, not after.

🏥

Provider Network Management

Onboard, tier, and manage your provider network digitally. Set tariff rates, empanelment criteria, and quality flags for each provider.

📊

Utilization Analytics

Real-time dashboards showing OPD utilization by geography, specialty, diagnosis, and member segment. Actioning data when it matters, not at month-end.

🔗

NHCX & ABHA Integration

All OPD transactions flow through the National Health Claims Exchange. Patient visit data links to their ABHA record for complete longitudinal health history.

How It Works

From card swipe to
claim settled in seconds

Cashless OPD replaces the phone-call authorization model with an instant digital workflow for payers, employers, providers, and members alike.

1
Member Visits Provider

Member presents their digital OPD card QR code at the reception desk. Provider scans and submits an authorization request in the app.

2
AI Validates in Real Time

Policy terms, remaining balance, benefit limits, and fraud signals are checked simultaneously. Authorization decision in under 2 seconds.

3
Provider Delivers Care

Authorization code is issued. Consultation proceeds. Provider submits the claim digitally no paper forms, no fax, no phone calls.

4
Auto Settlement

Claim is adjudicated against the tariff agreement and policy terms. Payment is scheduled within the agreed cycle all tracked in the payer dashboard.

Digital health benefit card usage at clinic
Impact

Real savings for
payers and employers

85%
Reduction in OPD authorization turnaround time
₹2Cr+
Average annual fraud savings per 10,000 members
4.8/5
Member satisfaction score with digital OPD experience

Launch your cashless OPD
program in 30 days

We'll handle provider onboarding, member card issuance, and NHCX integration. You focus on designing the right benefit.

Book a Demo →