Hospital tariff digitization for TPAs and insurers.
YIRA MedSense turns hospital tariff documents into procedure-level rate tables, applies your contract rules by room category, and keeps every missing rate visible as NA, so claims teams can check a bill against the agreed price in seconds.
Medically reviewed by Dr. N. S. Santosh Varma, MBBS, FIIM, FIDM, FICCM · Medical Officer, YIRA MedSense · Updated 12 October 2026
{
"procedure": "Cataract surgery",
"private_base": "₹17,000",
"general": "₹8,500 (−50%)",
"twin": "₹12,750 (−25%)",
"deluxe": "₹21,250 (+25%)",
"suite": "NA (rate not in tariff)"
}Illustrative example of contract rules by room category.
Every hospital prices differently.
Network hospitals send tariffs as PDFs and spreadsheets in their own formats, with different room categories, packages and exclusions.
Unstructured tariffs
Rates sit in PDFs, scans and spreadsheets that cannot be compared.
Room-category rules
The same procedure costs more or less depending on the room, under contract rules.
Silent gaps
When a rate is missing, teams guess, and the guess becomes leakage.
Manual bill checks
Every bill is checked by hand against a document someone has to find first.
From tariff document to rate table.
Read the tariff
MedSense reads tariff documents from scans, PDFs or spreadsheets.
Structure it
Procedures and rates become a procedure-level table per hospital.
Apply contract rules
Your rules by room category are applied, for example general, twin, private and deluxe.
Show the gaps
Any rate not in the tariff stays visible as NA instead of being guessed.
Cataract surgery by room category.
Illustrative example: private room base rate ₹17,000, with contract rules applied by room category.
| Room category | Rule | Rate |
|---|---|---|
| Private (base) | Base rate from tariff | ₹17,000 |
| General | −50% of base | ₹8,500 |
| Twin sharing | −25% of base | ₹12,750 |
| Deluxe | +25% of base | ₹21,250 |
| Suite | Not in tariff | NA (shown, not guessed) |
Illustrative figures. Your own contract rules are configured during provisioning.
For network, claims and finance teams.
Provider network teams
Compare hospital tariffs side by side.
Claims teams
Check bill lines against the agreed rate.
Fraud teams
Spot billing above contract rates.
Hospitals
Share tariffs payers can read straight away.
In production at Health Assist Insurance TPA.
MedSense has parsed more than 1 lakh (100,000+) medical documents, flagged over 5,000 fraud cases for review and supported 100+ insurance operations.
Sandbox
Test MedSense on your own sample documents.
Provision
Set up document types, fields and rules.
Integrate
Connect by API to your claims, TPA or hospital system.
Go live
Run in parallel, then switch over.
Timing depends on scope, data access and integration readiness. Client-managed deployment is available, so MedSense can run inside your own infrastructure.
Questions from claims teams
What is hospital tariff digitization?
Converting hospital tariff documents, such as PDFs, scans and spreadsheets, into structured, procedure-level rate tables that claims and network teams can search and compare.
How does MedSense apply room-category rules?
Your contract rules are configured during provisioning, for example a percentage below or above the base rate for general, twin or deluxe rooms, and MedSense applies them to every procedure in the tariff.
What happens when a rate is missing?
It stays visible as NA. MedSense does not guess missing rates, so gaps can be raised with the hospital instead of becoming leakage.
Can MedSense compare a hospital bill with the tariff?
Yes. Bill line items are extracted from hospital bills and can be checked against the structured tariff for the right room category.
Which formats can MedSense read?
Scanned PDFs, digital PDFs, photos and spreadsheets.
Who uses tariff intelligence?
TPAs, health insurers, provider network teams and hospitals. Health Assist Insurance TPA uses MedSense in production.
How long does a rollout take?
About 4–5 weeks from sandbox to go-live, depending on scope, data access and integration readiness.
Book your demo today.
See MedSense on the documents and fields that matter to your claims team.