Provider billing is the work a clinic or hospital does to get paid for treating a patient. In the United States, it is also called medical billing, and the whole process is called the revenue cycle. Most of an American provider's money comes from the patient's insurer, not from the patient.
The work has five steps. First, before the visit, the clinic checks that the patient's insurance covers the visit. This is called an eligibility check. Second, for some treatments, the clinic must get the insurer's approval in advance. This is called prior authorisation. Third, after the visit, a medical coder reads the doctor's note in the electronic health record and turns it into medical codes. Fourth, the clinic sends the claim to the insurer. Fifth, if the insurer denies the claim, the clinic corrects it or appeals. At the end, the clinic collects whatever the patient still owes.
Three kinds of product do this work. A revenue cycle management (RCM) system holds every claim and shows where each one has reached. A healthcare clearinghouse checks the format of each claim and delivers it to the right insurer. AI medical billing agents do the work itself: they draft the codes, the claims and the appeals, and a person checks them. One of these agents is an AI voice agent for payer calls. It phones insurers about unpaid claims, calls that used to keep billing staff on hold for hours.
India matters to this zone in two ways. First, a large share of the people who code and bill American visits work in India, in centres in Chennai, Hyderabad, Bengaluru and Delhi. For instance, a coder in Hyderabad may code the day's visits to a clinic in New Jersey overnight, so that the claims go out the next morning. Second, Indian hospitals have a revenue cycle of their own. It is built around cashless claims, which more and more pass through the National Health Claims Exchange.