Does a query stop the TAT clock? One file, two answers
One invented cashless file, timed two ways: with the clock running straight through it is late, with a pause for the hospital’s reply it is on time. What the circular says, and what practice does.
Published 1 November 2026.
A hospital sends a cashless request. The insurer asks a question. The hospital answers. While the insurer waits for the answer, does the one-hour clock keep running? The choice changes the verdict on the same file, as one invented example shows.
One invented file
The request is received at 10:00. At 10:20 the insurer sends the hospital a query. The hospital replies at 11:10. The insurer decides at 11:35.
If the clock runs straight through
From 10:00 to 11:35 is 95 minutes. The limit is 60. The decision is 35 minutes late.
If the clock pauses while the file waits for the hospital
The clock runs from 10:00 to 10:20, which is 20 minutes, and then stops for the 50 minutes the file waits for the hospital. It restarts at 11:10, when the reply arrives, and runs to 11:35, which is 25 minutes. The total is 45 minutes, inside the 60, with 15 minutes to spare.
The events are the same in both. Only the view of the clock differs, and with it the verdict.
What the regulator says
The circular text read for this site gives the one-hour and three-hour limits as running from receipt of the request, and says nothing about pausing them while a query is open. Whether a pause is allowed is a matter for the regulations and the policy contract, so a statement that a query always stops the clock, or never does, should be treated with care.
Basis: Official text. Master Circular on Health Insurance Business, 29 May 2024; Master Circular on Protection of Policyholders’ Interests, 5 September 2024.
What happens in practice
In general practice across insurers and TPAs, the clock is treated as paused while the file waits for the hospital’s reply and restarts when the reply arrives. That is practice, confirmed by the site owner on 1 November 2026, not a rule found in the circulars.
Basis: Practice.
Why the times matter on a real file
Because the same events can give a late verdict or an on-time one, the times of the query and of the reply are worth recording on a file. In claims practice, several small queries one after another cost much more time than one complete query, and the wait for the hospital’s answer is part of why a file runs long.
Basis: Practice.
Try the timer
Worksheet 1 checks a request time and a decision time against the one-hour limit, and a discharge request and final authorisation against the three-hour limit. It does not pause the clock, so it shows the straight-through view. The claim lifecycle page explains each limit with its source.
Related: Claim lifecycle. All notes.
Every case on this site is synthetic. These are working drafts and illustrations, not a claim decision or legal advice. The interactive worksheets need JavaScript; nothing is sent anywhere.