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Third Party Administrators for Health Insurance

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 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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If you have a question about health related issues, you can now post it in our Ask An Expert section on our community website Medwonders.com and get answers from our panel of experts.
Posted by:  kakatiyamohan(Guest)  Posted on: 05/23/2012
kindly update latest data and information



Posted by:  saravks  Posted on: 04/10/2012
Sir
Im working as PRO in a reputed hospital in salem, Tamilnadu. Looking for new tie up's with listed TPA's in this site. Request to please suggest me which are the companies that provides services in Tamilnadu region and also the process of tie up with those companies.



Posted by:  vandna1977(Guest)  Posted on: 02/20/2012
Please provide me with name of TPA's recruting docs or some placement consultancy in Chandigarh or punjab, please.



Posted by:  santosh92(Guest)  Posted on: 02/10/2012
Please send me the list of DHS hospitals in navi mumbai Vashi.



Posted by:  a.dube(Guest)  Posted on: 01/03/2012
sir, i am running a hospital at raipur chhatisgarh and associatted with rsby and central govt kindly send detail for empanellment.



Posted by:  SANJIVANI-FAMILY-HOSPITAL  Posted on: 12/29/2011
Sir, We are running a hospital in Orissa and have MOU with a number of TPAs for cashless treatment of their clients. Some of them are either not paying the claims in time or making arbitrary short payment and do not care to give justification for this. Our concern is as to what is the forum for lodging the complains in this regard.



Posted by:  Shokhi  Posted on: 12/04/2011
Hi m looking for job in TPA , have got 2.6 yrs of experience in Claims adjudication in Health Insurance from International BPO.



Posted by:  rajivdr(Guest)  Posted on: 12/03/2011
i am physician running 15 bedded hospital in punjab iwant to empanel with TPA.kindly tell me the procedure



Posted by:  navs2009  Posted on: 11/24/2011
i am gen.surgeon.running 20 bedded hospital.i want to empanel with TPA.what is procedure



Posted by:  muzammil_qureshi2002(Guest)  Posted on: 10/27/2011
Kindly please send me someone TPA list of Haryana on muzammil_qureshi2002@yahoo.com




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