TPA (Third Party Administration) has been a very common term in the insurance sector. This is an organization certified and licensed by IRDA (Insurance Regulatory and Development Authority of India). IRDA has strict norms to select TPA that will take care of the insurance claim made by the policy holders.
TPAs connect insurance companies and their policyholders by resolving the tricky matters like claim settlement. India, TPA has been initiated in 2001 and since the health insurance sector has gone through lots of changes. Evolution happens every year and terms and conditions are changed accordingly. The number of companies showing interest in this particular field is growing with time. As per the recent data, the health insurance companies witness a remarkable growth.
Since health insurance has become a necessary factor of our lifestyle, people take a relief under the health insurance coverage with large volumes. With an increased rate of medical bills, people choose preventive measures over the curing formula. Health insurance seems to be considered as an intelligent decision that takes care of your need and wellness when the ill health occurs.
The TPA is seen as the most important discussion in the health insurance sector. Numerous ways are invented to improve the product quality, but TPA seems to be the first one that is designed to enhance the service of the company.
The recent survey on health insurance brings to the people the fact that people, who are insured under an insurance plan, have a little knowledge about the health plans and their coverage. In India, nearly 50-60% working class individuals have a plan, but they completely ignore the in-detail knowledge of that health plan.
The content tries to point out those common facts that people have been taking along wrongly. The best insurance plan will be the one that suits your every need and demand. For this, you have to have a clear idea of what your insurance plan covers. Below are few points that present the myths of health insurance plans.
The roles of TPA
With the introduction of TPA, insurance companies find a great relief to manage the claim details and keep the service charges within the limit. The working area of TPA is larger than you expect. These firms have each note of your claim so that they can process your application at an earliest. The complete job responsibilities of TPA are given below.
Enrollment process: AN ID card is provided by TPA to all policyholder to validate their identification during the hospitalization.
24 hours customer support service: TPAs will always get in touch with you at the time of hospitalization to look after your claims and charges of empanelled hospitals of the companies.
Claim process: TPA takes care of the claim process and checks it will be cashless or reimbursement claim.
Investigation and check fraud claim
Empanelment of hospitals
Claim intimation process is one of the important areas of a health insurance policy. The insured individual must inform the company or TPA about the claim within a stipulated time frame. The TPA must be informed by a written letter, fax, email, or by phone about the claim. The insured person must submit all essential documents such as consultation report, diagnosis, plan of treatment, discharge summery, and identity proof to back their claim. Certain rules must be followed by the individual and this is discussed below:
Policyholder must inform TPA to the toll-free number provided to them.
The policyholders will be directed to the empanelled hospital. They can choose the hospital of their choice, though. In this case, the reimbursement claim process will be applied.
PA wants you to submit an authorization letter of the hospital where the policyholder is admitted in.
The medical expenses bills must be sent to the TPAs because they check the details and then process your claim.
TPA complements the payment procedure of the hospital.
TPA contacts to the insurance companies and informs them about the claim and payment details along with bills and paper documents.
The insurance companies, after analyzing the details sent by TPA, reimburse the amount to them.
A few things you need to keep in mind for the claim settlement
Cashless settlement and reimbursement settlement:
For planned hospitalization, TPA should be intimated 72 hours before the insured individual gets hospitalized in the empanelled hospital. The same thing is followed by the reimbursement settlement as well.
In case of emergency hospitalization, TPA should be informed less than 24 hours prior to the hospitalization of the insured person in the empanelled hospitals. The time limit remains 72 hours prior to the hospitalization for reimbursement.
TPAs are working at length to fulfil the growing demand in the healthcare sector. They check every claim and come up with the desired solution.