Cashless agent mesh
Automated cashless authorisation + discharge handling against the regulator clock — no human queue.
Gooclaim OS
Use case · TPAs
For TPAs. The hidden bottleneck, now automated.
TPAs sit between insurers, hospitals and members — yet have zero modern multi-channel infrastructure. Gooclaim OS plugs into the existing CMS and turns cashless ops into a default, not a fire drill.
IRDAI 1hr / 3hr SLA trackingPer-insurer audit ledgerMulti-tenant by design
The problem · in one number
6–8 months
hospital dues delayed by TPAs
The IRDAI 1-hour admission / 3-hour discharge mandate is now law. Without automation, every breach costs Bank Rate + 2% daily — a penalty TPAs can no longer absorb manually.
Moneylife · IRDAI Master Circular (29 May 2024) · PPHI Circular (Sept 2024)
What Gooclaim OS does for TPAs
Multi-channel patient layer
WhatsApp + Voice + SMS for members, the same OS hospitals can pull status from.
Read your CMS, never write
Plug into your existing TPA platform — modern or legacy — without write-back risk.
Audit-grade per insurer
Immutable ledger per partner insurer, IRDAI-format export on demand.
Hospital sync
Hospitals see the same real-time state members do — no more “TPA blamed” loops.
Penalty avoidance
SLA observability per workflow, alerts before a Bank Rate + 2% breach is logged.
Who this is for
Three people own this in your org.
Gooclaim OS shows up first for these roles — but the platform serves the entire claim chain.
Head of Claims Ops
Owns the 1hr / 3hr SLA against the regulator clock.
COO
Owns daily penalty exposure and hospital-network goodwill.
Compliance Officer
Owns the IRDAI audit trail and ombudsman exposure.
From regulatory exposure to a competitive moat.
Show insurers and hospitals real-time status, audited every step. The TPA that automates first wins the next book.