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Third Party Administrator for Claims and Cashless Health Insurance - About
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Third Party Administrator for Claims and Cashless Health Insurance
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TPA (Third Party Administrator) for Claims and Cashless Health Insurance
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 in the world of health insurance and how the TPA are changing the face of health insurance.){kind=small} |  |
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TPA is also involved in handling employee benefit plans such as processing retirement plans. Handling healthcare or employee benefit claims requires using a specialized set of manpower and technology, therefore hiring a TPA for the same is a more cost effective method.  The Insurance Regulatory and Development Authority of India (IRDA) defines TPA as a Third Party Administrator who, for the time being, is licensed by the Authority, and is engaged, for a fee or remuneration, in the agreement with an insurance company, for the provision of health services. TPA was introduced by the IRDA in 2001. Being one of the prominent players in the managed care industry, it has the expertise and capability to administer all or a portion of the claims process. The services include claims processing, premium collection, enrollment and cashless processing. Insurance companies setting up its own health plan often outsource certain responsibilities to a TPA. The TPA acts like a claims adjuster for the insurance company. In some cases the insurance company sets up an entire department within their own company to act as TPA as opposed to hiring a commercial TPA company. |
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Posted by:
B.R.Khanna
Posted on: 01/25/2013 Health insurance consists of Pre Hospitalisation, Hospitalisation and Post Hospitalisation. But normally it is seen that Pre and post hospitalisation are not cared by TPAs. They pay only for hospitalisation in cashless claims to hospitals. If in a cashless claims, if an insured is late to intimate to TPA while still in Hospital, the tPA does not entertain cashless service. What are the reasons ?
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Posted by:
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Posted on: 01/24/2013 Q. MY FATHER WAS ADMITED IN APOLLO HOSPITAL, KOLKATA ON 17.1.2013 AT 2.45PM, AND RELEASED ON 21.1.2013 AT 9.45AM. HOSPITAL AUTHORIYT SEND THE FINAL BILL AT 10.00AM ON 21.1.2013 FOR CASHLESS APPROVALTO TPA [Emeditek] FOR 5 (FIVE) DAYS. BUT TPA SEND THE APPROVAL AT 4.30PM FOR 4 (FOUR) DAYS, BECAUSE THR 5TH DAY NOT COVERING 24 HOURS. WHAT IS THE RULE OF IRDA and AM I CASH BACK FOR THE 5TH DAY'S AMOUNT ON REIMBURSEMENT BASIS? |
