Third Party Administrator TPA In Health Insurance Explained
Updated On Oct 20, 2020
Set up by IRDAI in 2001, Third Party Administrators (TPA) are a group of agencies or companies that are assigned with the duty to provide assistance to insurance providers in the process of claim assistance in the place of the insurer. They are often referred to as the pillar of leading health insurance companies due to their help in seamless settlement of the claims.
How Does The TPA Function?
TPAs are a third-party individual body, licensed by the IRDAI to provide multiple flexibility solutions and assist insurance companies. They are the bridge between an insurance company and its policyholder who ensure seamless settlements of claims. TPA’s are majorly responsible to take the load off insurance companies and guide its policyholder’s over every step of claim settlement with the company.
TPA’s inform the client about the closest hospital under them and also provides clients with help at every step from admission to discharge of the patient. They are also responsible for the reconciliation of statements that are sent to them and process the claims on behalf of the policyholder.
Third-Party Administrator And Its Role In Health Insurance
The third-party administrator or the TPA plays an essential role in helping holders with the entire process of facilitating cashless claims. Let’s have a look at how TPA provides assistance:
- Seamless settlement of claims
- Pre-authorization with the hospitals
- Providing a list of hospitals under the insurance companies
- Processing cashless claims
- Ambulance services
- Tracking of claims
- 24*7*365 helplines
- Other healthcare facilities
Listed below is an updated list of some of the TPA’s, suggested by IRDAI:
|Name Of The TPA||Name of CAO/ CEO/ Address||Contact Details|
|United Health Care Parekh Insurance TPA Private Limited||Mr. Shiva Belavadi||Toll Free No.: 1800 209 8884|
|Chief Executive Officer||Email: firstname.lastname@example.org|
|MDIndia Health Insurance TPA Private||Mr. Suresh V. Karandikar||For senior citizens: 020-25300126|
|Chief Executive Officer||Toll Free No.: 1800 233 1166|
|Fax : 1860 233 4449|
|Vision Digital Insurance TPA Private Limited||Ms. Priyanka Jain||Toll free no: 1800-419-9982|
|Ph. No.: 0124-4003171|
|Chief Administrative Officer|
|Ericson Insurance TPA Private Limited||Dr. Krishna P. Jaiswal, MD||Senior Citizen Helpline No.: 022-25280208|
|Ph. No.: 022-25280280|
|Toll Free No.: 1800 22 2034|
|Anmol Medicare Insurance TPA Limited||Mr. P. S. Kshatriya||Toll Free No.: 1800 233 1999|
|Chief Executive Officer||Ph. No.: +91-79-61609926, 61609930|
|Park Mediclaim Insurance TPA Private Limited||Mr. Anurag Bhatnagar||Toll Free No.: 1800 11 55 33|
|Chief Executive Officer||Ph. No.: 011-43191000|
|Website : www.parkmediclaim.co.in|
|Good Health Insurance TPA Limited||Ms. Saigeeta Dikshit,||Senior Citizen Toll Free No.: 1800 102 9919|
|Toll Free No.: 1860 425 3232|
|Chief Administrative Officer|
Note: The data in the above table has been sourced from the official IRDAI website.
Lastly, TPA’s are also responsible for the proper management and investigation of the cases. However, it should be noted that they are just the medium to get your claims settled and don’t have any major say in the claim settlement process.
Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.