The concept of TPA or the THIRD PARTY ADMINISTRATOR has been introduced by IRDA (Insurance Regulatory and Development Authority) for the benefit of both the insured and the insurer. While the insured is benefited by quicker & better service, insurers are benefited by reduction in their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. In brief, the job of the TPA is to maintain databases of policyholders and issue them identity cards with unique identification numbers and handle all the post policy issues including claim settlements. In terms of infrastructure, the TPA will need to run a 24-hour toll-free number, which can be accessed from anywhere in the country. And they will have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy
Advantages of TPA
1. The policyholder will have full freedom to choose the hospitals from the empanelled network and utilise the services as per his/her choice
For every hospitalisation, the policyholder will be well aware whether the treatment he/she is to undergo is covered under his policy or not. If covered, then he/she can seek cashless facility without having to pay a single rupee at any of empanelled hospitals.During the time of Emergency Hospitalisation, the policyholder or relative can flash the Photo ID Card of the policyholder and gain admission into any of our network hospitals.
2. Priority treatment at hospital is given without any payment to be made at the any time of admission. So also at the time of discharge, no payments to be made. Thus, a complete CASHLESS TREATMENT.
Thus, the Individual does not run around for arranging cash for paying for the hospital expensesá
TTK as your TPA
1. All the records of medical insurance policies of an insurer will be transferred to the TTK.
2. TTK will issue identity cards to all the policyholders, which they have to show to the hospital authorities before availing any hospitalisation services.
3. In informing the TTK, policyholder will be directed to a network hospital where the TTK has a tied up arrangement. However policyholder will have the option to join any other hospital of his choice, but in such case payment shall be on reimbursement basis.
4. TTK issues an authorisation letter to the hospital, for the treatment wherein TTK will pay for the treatment.
5. TTK will be tracking the case of the insured at the hospital and at the point of discharge, all the bills will be sent to TTK
TTK makes the payment to the hospital.
6. TTK will send all the documents necessary for consideration of claims, along with bills to the insurer.
7. Insurer reimburses the TTK
Scope of TPA
The scope of services will include:
a) Issue of Identity card to all policyholders.
b) Provide information to policyholders about hospitals.
c) Provide Cashless access in TTK network hospitals.
d) Process claims.
e) Provide 24 hours, 7 days a week customer service toll free number TTK Technology
Every service rendered to TTK Health Card holder is backed by technology, which helps in achieving better service and increasing customer satisfaction levels. We are backed with high-end IT support system which is Web Enabled so that the Policy Holder / Service Provider / Insurance company, can access relevant information anytime as required.