A common term which you might hear when getting health insurance is Third Party Administrator. It is important to get acquainted with the concept and to know about what is its role and then move into the other complex segments. It is important to know about it to make an informed decision.
What Third-Party Administrator?
The third-party as the name simply signifies is someone or an organisation which is the third party and is the administrator. TPA is the abbreviation for Third Party Administrator. So, this is someone who is not directly involved in the administration process of the services which are mentioned in the contract.
What does it mean in a Health Insurance?
Health Insurance has a much wider scope in comparison to other insurance, be it a vehicle or something else. This is the only reason this insurance involves a lot of terminologies which is why the process could sometime look complex to a person. One of these terminologies is the Third-Party Administrator.
It is a third-party entity and administers the claim settlement aspect of the contract between the one who the policy and the insurer.
Functions of TPATPA is the link between the insurer and the policyholder in case a claim is made.TPA is chosen by a health insurance firm.TPA makes the claim process easy by dealing with the documents and settling the hospital bills. TPA's are licensed by the Insurance Regulatory and Development Authority of India.TPA can be in link to various policyholders. These are associated with the smooth settlement process.
Role of TPA in Health Insurance
All the records which are crucial to the policyholder are maintained by the TPA. These records are stored in a dedicated database.
Several TPAs have 24x7 support. It is important to keep in mind that they are there to make the settlement process easy for the policyholder and are often present in case of any queries. This support is offered by call and even application.
In case of any hospitalization claim, the policyholder directly or indirectly deals with the TPA. The TPA is the one that offers a unique identification number to the patient which alters helps in the claim settlement.
TPA also checks whether the hospitals meet the criteria which are part of the network hospital chain and might offer extra services related to ambulance, extra beds, medicine supply's, etc to the policyholder.
The role clearly defines the benefit of the TPA which in one sentence is very simple. It helps in the settlement process to the insurer. It gives a 24x7 support and handles all the technical stuff from handling document to providing ID numbers.
There is also a possibility of chances of cancellation of TPA if you need it or you can also change one by reaching out to your insurance company. You must have to explain the reason for the cancellation of TPA and it will only cancel after the approval.