Third Party Administrators for Health Insurance

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Services offered by the TPA

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The TPA undoubtedly aims to give the health insurance industry the required boost in India.  

The services provided by TPA are as follows:

  • ID card: TPA provides ID cards to all their policyholders in order
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    to validate their identity at the time of admission.
  • The TPA's undertakes "Pre-authorization" before a surgical procedure to ease claim processing
  • 24 hours customer support services: The TPA provide assistance through their 24 hrs call center that provides information regarding policyholder's data, provider network, claim status, benefits available with existing cardholder, etc All these details are furnished on request.
  • Cashless Hospitalization: Each policyholder is provided with a list of empanelled hospitals where in he/she can avail cashless hospitalization.
  • Claim Management: On behalf of the insurance companies TPA administers and settles claims for hospitals and policyholders.

Policyholders have the privilege of expressing their grievances to the concerned insurance company or at the consumer's court if they are not satisfied with the services of a TPA.

 The specialized functions of the TPA include:

  • The TPA keeps and maintains all the records of medical insurance policies of an insurer.  
  • The TPA issues identity cards to all the policyholders. The policyholders will have to show the identity cards to the hospital authorities before availing any services from the hospital.
  • In case of a claim, policyholders will  have to inform the TPA on a 24 hr toll- free line provided by them
  • After informing the TPA, the policyholder will be directed to a hospital where the TPA has a tied up arrangement. However, policyholders have the option to be admitted at another hospital of their choice in which case, payment will be on reimbursement basis.
  • TPA pays for the treatment; they issue an authorization letter to the hospital for the admission of the policyholder in the hospital.
  • At the point of discharge, all the bills will be sent to the TPA while they are tracking the case of the insured at the hospital.
  • TPA makes the payment to the hospital.
  • TPA sends all the documents necessary for consideration of claims, along with the bills to the insurance company.
  • The insurance company then reimburses the TPA
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HIHO123 Wednesday, May 11, 2016

The TPA concept took 15 years to come up though IRDAI approved the same long back in 2001. The benefit of TPA to the Insured has not improved any significantly except that the present TPA has just taken over only the fee part of the Insurer companies and to ensure that the claim gets reduced to the least. The facilities offered by them and to start with their 24X7 service to policy holders may kindly be seen. The vision statement states about eradication of fraudulent claims as if the health insurance industry was infested with this malaise in India. It says brightly about flashing I Card and about cashless treatment but it is equally silent why a payment under a covered illness will be postponed and it will be treated as a claim afterwards. At the time of discharge, the TPA will pay what it is supposed to pay and the rest will be borne by the patient. The introduction of pre-authorization approval has been made the monopoly of TPA which is wrong. It is just reaping the benefit of insurance without being responsible for it. IRDAI has a big role now.

nbnrc Thursday, February 25, 2016

Dear Sir, I am working as PRO in a reputed hospital in siliguri West Bengal. Sir we are tied up with Med India as well in order make our communication active kindly suggest me something.

okeeyehospital Sunday, January 3, 2016

Dear Sir
We, Oke eye hospital, Nagpur is a established eye care center at Nagpur, Maharashtra. we are empanelled with most of the TPAs working in this area. we have approached the TPA Mediassist couple of times sending our full information for getting empanelled. in last 3 years we have not been given any response. It causes lot of inconvenience to those patients who intend to get their surgeries done at our hospital and they have to adopt the course of reembursement. Kindly guide us regarding the proper mode of approaching Mediassist TPA.

mediclaim_disease Wednesday, April 17, 2013

pls. let me know the list of diseases under reimbursement from national insurance co limited.

seo2012 Thursday, April 4, 2013

For any insurance query please dial 1800113538. need any information about any policy please contact health insurance india. our expert feeling happy to help you.

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