Third Party Administrators for Health Insurance

Rating : 12345
Rate This Article : 1 2 3 4 5
G J E 4
A -A +

Services offered by the TPA

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

Show More Related Topics y

Post your Comments

Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.
User Avatar
* Your comment can be maximum of 2500 characters
Notify me when reply is posted I agree to the terms and conditions
pls. let me know the list of diseases under reimbursement from national insurance co limited.
mediclaim_disease Wednesday, April 17, 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.
seo2012 Thursday, April 04, 2013
Hi I am Sunita looking for consultant/recruitment firm which will help me to get the job in UAE
sunitajoshi077 Sunday, February 17, 2013
Sir the insurance co with which my company has a tie up has dhs as tpa. Some of the hospitals in bangalore are not providing cashless facility for dhs and asking me to pay and then claim. Now the issue is that for same treatment costing Rs 45000 under cashless I am being ask to pay Rs. 60000.This is 33% more than cashless. I m surprised at this and seek help/ suggestions from all. The hospital in question is Cloud Nine hospital in. Bangalore. Thanks in advance for all guidance. Roshan
Rosh81 Monday, September 17, 2012
for a pure latest policy table etc. visit www.healthinsuranceindia.org or call toll free on 1800113538
seo2012 Saturday, October 19, 2013
kindly update latest data and information
kakatiyamohan Wednesday, May 23, 2012
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.

saravks Tuesday, April 10, 2012
Please provide me with name of TPA's recruting docs or some placement consultancy in Chandigarh or punjab, please.

vandna1977 Monday, February 20, 2012
Hai you looking for consultancy firm well we are from bangalore and we recruit for entire regions and all domains contact me 91 7829877154 bangalore.
swetha.R Wednesday, November 28, 2012
Please send me the list of DHS hospitals in navi mumbai Vashi.
santosh92 Friday, February 10, 2012
visit www.healthinsuranceindia.org for up to date info of insurance divisions in india
seo2012 Saturday, October 19, 2013
sir, i am running a hospital at raipur chhatisgarh and associatted with rsby and central govt kindly send detail for empanellment.
a.dube Tuesday, January 03, 2012
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.
SANJIVANI-FAMILY-HOSPITAL Thursday, December 29, 2011
View all Comments

Ask an Expert

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.

Join Our Online Health Community:

Recommended Groups Members Related Discussions
By registering with Medindia you become part of our global health community. Make new friends and share and discuss your health issues, with 138137 other members across 445 support groups.

Most Popular News on Medindia

View All >>
s Third Party Administrators for Health Insurance - Advantage /Check list
Third Party Administrators for Health Insurance - ...
S Third Party Administrators for Health Insurance - What is a TPA?
Third Party Administrators for Health Insurance - ...