What Is TPA In Health Insurance?
How TPA Streamlines Health Insurance Claims
A TPA or a third-party administrator is a company that helps insurance companies manage claims on behalf of policyholders. IRDAI (Insurance Regulatory and Development Authority of India) licenses TPAs that are specialised to carry out the following administrative work under health insurance:
●Claims process
●Cashless hospitalisation
●Documentation.
TPA's Role in Health Insurance
Here is an outline of the TPA's primary roles:
●Claims Management
TPA works on the entire claim process. The policyholder enjoys all the benefits and never has to face the insurer. They check into the claim, investigate the coverage of the policy, and settle claims as sanctioned by the insurer on their behalf.
●Cashless Hospitalisation
Maybe the biggest service that TPAs are supposed to provide is to offer cashless treatment at networked hospitals. Whenever a policyholder requires hospitalisation, the policyholder settles the hospital bills directly with the insurance company. So, zero amount is drained out from the insured's account on the first go.
TPAs usually open help desks in most network hospitals to make the claim process easier for policyholders. Additionally, they assist with verifying and processing the required documents to ensure smooth admission and discharge.
●Policyholder Support
TPAs offer 24/7 customer support for all claims-related queries of the policyholder, pre-authorisation for treatments, and an explanation of the terms of the policy. They also maintain a database of hospitals, policy details, and claim history for easy reference.
Some Key Features of TPA
●Network Hospital Management: TPAs sign agreements with hospitals in all the regions of the country and increase the insurer's cashless treatment network.
●Claim Pre-Authorisation: TPAs pre-authorise the claim after verifying policy terms to avoid delay in accessing care.
●Effective Documentation: TPAs collect, verify, and submit documents ensuring that claim settlements are done promptly and accurately.
Benefits of TPA to Policyholders
●Hassle-Free Claims: TPAs streamline the process of claims and ensure that cashless and reimbursement claims, resulting in less paperwork, are approved more quickly.
●Easy Access to Cashless Treatment: Extensive networks of hospitals offer policyholders access to cashless treatment under all types of healthcare facilities offered by TPAs.
●24/7 assistance: TPAs ease out the process of getting assistance at any given time to a policyholder in case of a medical emergency.
Do All Insurers Use TPA?
Not all health insurance providers rely on TPAs to manage claims. While TPAs offer many benefits, their involvement can sometimes lead to delays in claims processing due to procedural complexities. Moreover, not TPAs are equally efficient in managing claims, and some may have operational inconsistencies.
Unlike many insurance companies that use third-party administrators (TPAs), Star Health Insurance handles claims directly, which leads to quicker and more personalised service. Thus, you can have an easy claim-settling experience. Contact Star Health Insurance and get the benefits of direct, faster claims processing.