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What is TPA in insurance (Understand its concept and role)

A medical emergency is something that comes unannounced, so it is imperative to get health insurance. TPA is a word you often hear while looking for health insurance. But, what is TPA is insurance, and how does it work? This article will explore this concept in detail and help you understand the role TPA has in health insurance.

What is TPA in insurance?

Third-Party Administrator is TPA insurance full form. It is an entity that manages insurance claims that are protected by the Mediclaim scheme. These managers are usually self-contained but may also serve as a representative of the insurers.

The need for the concept of TPA

An increasing number of health insurance policies dispensed by insurers has made maintaining a record of every task done challenging, resulting in a reduction of the quality of services provided. TPAs were established as a result of IRDA’s efforts. Ever since it has been considered accountable for the following:

  • Hassle-free quality services.
  • Managing a vast number of health insurance claims.

Role of TPA in health insurance

TPA in insurance means an entity that is essential for the overall handling of health insurance claims. Some of the roles of TPAs in health insurance can include:

1.) Provide the insured with their health cards

A validation process is carried out by issuing a valid health card for each policy issued. This card includes information about the policy number as well as the TPA in charge of processing the claim. This document is extremely important to acquire health insurance claims.

For instance, if a person with health insurance gets injured, he has to show this card and inform the TPA or insurer of the details of the claim while being admitted to the hospital.

2.) Production and resolution of claims with ease

A TPA is accountable for expediting a claim as quickly as the insured tells them of it. Their duty is to go through all of the submitted records. The TPA may request as many details as is required to double-check the data. The claim will be settled either cashlessly or on a refund basis.

In any case, a TPA would be responsible for inspecting all records. The TPA will obtain the documentation from the hospital in the case of a cashless settlement. In other situations, the TPA can request the favoring documents and bills from the insured.

3.) Customer support helpline

Policyholders can contact their TPA to receive help with their claim or to clear any related queries through a toll-free number 1800-258-5956. This facility is available 24 hours a day and can help you track the status of their claims.

After knowing what TPA is in insurance, it’s safe to say that the presence of a third-party administrator (TPA) in the insurance business makes the different steps of a health insurance policy much simpler and quicker for you. Furthermore, TPAs become a great help for policyholders by providing much-needed claim assistance.

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