Published Article Details

What is a third party administrator in health insurance?

Posted by: Labdhi Mehta on Jan 15, 2018, 06.30 AM IST

1) TPAs function as intermediaries between the insurance provider and the policyholder and its key function is processing of claims and settlement.
2) The TPA issues ID cards to policyholders, which have to be shown to the hospital authorities before availing any cashless hospitalisation services.
3) At the time of a claim, a policyholder has to inform the TPA. He will be directed to a hospital the TPA has a tie up with. He can opt for another hospital, but then payment will be a reimbursement.
4) TPA issues an authorisation letter to the hospital, after which they track the case and at discharge all bills are sent to TPA for payment.
5) TPA sends all the documents necessary for consideration of claims, along with bills, to the insurer.

The content on this page is courtesy Centre for Investment Education and Learning (CIEL).
Contributions by Girija Gadre, Arti Bhargava and Labdhi Mehta.
This article appeared in Economic Times dated Jan 15, 2018, 06.30 AM IST

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