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What is a Third Party Administrator (TPA) & How does it work?

Third Party Administrators (TPA) is an important link between Insurance company’s policyholders & healthcare providers (Hospitals and nursing homes).TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.
Service offered by TPA for policyholder & Health care provides & Healthcare Provider
1. Cashless Hospitalization : Each Policy holders is provided with a list of empanelled hospitals where in he/she can avail cashless hospitalization
2. ID card : TPA provides ID cards to all their policy holder in order to validate their Identity at the time of admission
3. Claims Management :
4. 24 hours customers support services : TPA provides assistance through its 24 hrs call center information regarding policyholder’s data, provider network, claim status, benefits available with existing card holder, etc is furnished on request.

If you have a medical insurance please check out the following details :

Have you received the insurance cards from Third Party Administrator? If not contact your agent or TPA.
If you have received the Insurance ID cards check the name of the TPA before getting hospitalised.

If you have fresh policy / first year policy or recently got your policy renewed check with your TPA about your policy enrolment, failure of which can result in rejection of your cashless authorisation request.
Medical insurance do not cover your OPD consultation / procedure / investigation done before being hospitalised.
All claims of the discharge from the hospitals will be processed by the TPA directly / or for reimbursements of all your post discharge expanses directly file all originals documents, bill, prescription in TPA.


This post first appeared on TREATMENT - ORIGIN, please read the originial post: here

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What is a Third Party Administrator (TPA) & How does it work?

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