Cashless Treatment (TPA)

The generally used term in insurance is third party adminstrator. what’s third party administrator in insurance? Third Party Administrator also referred to as TPA acts as an interface between the insurer and therefore the policyholder. it’s a company/agency/organization that operates under the license of the Insurance Regulatory and Development Agency (IRDA). TPA is hired by the insurer to supply processing of claim during a cost-effective, timely, and hassle-free manner. One TPA are often related to multiple insurers. Mostly TPA do work as a unit of insurance companies, but in some case, they also work independently. TPA in insurance helps in claim assistance, processing claims, and providing cashless facilities to the policyholder.

What is Role of TPA?

First Role

• First point of contact between the insurer and policyholder – Third party administrator in insurance companies act as an intermediary between the insurer and therefore the policyholder. just in case of any claim related issues, the insurer contacts the concerned TPA.

Second Role

• Maintaining policyholder records – After the policy is issued, all the records and documents related to the insured are transferred to the TPA. TPA maintains the record of policyholders and assumes almost all responsibility for the insured. A identity card with a unique identification number is usually issued to the policyholder by the TPA.

Third Role

• Claim settlement – Among the varied third party administrator services, this is usually one among the foremost important functions of TPA. TPA generally coordinates with the hospital for the claim settlement process. The hospital shares the bills associated with the treatment of the policyholder. The TPA team crosschecks it consistent with the terms and conditions of the policy. just in case TPA has doubts regarding any claim, it can choose a second opinion or also can investigate hospital records.

Fourth Role

• Cashless processing – When a policyholder receives treatment in network hospitals, TPA assists with the cashless processing of the claims. All the documents associated with the availed treatment are provided to the TPA. The documents are verified by the TPA then the bills of the hospital are paid as per the policy cover. One thing to notice , for cashless processing, you would like to go to the network hospitals that fall into your insurer. choosing a cashless claim depends on you and isn’t compulsory.

Fifth Role

• Empanelling hospital within the network – Third party administrator in medical insurance is liable for building a hospital network for cashless services. While empanelling hospital within the network, it takes under consideration the infrastructure, facilities provided by the hospital, its record, etc. once you buy a health policy, you’re given a kit containing a Guide Book and an inventory of Network Hospitals. Moreover, you’ll also get to understand about the network hospitals from your third party administrator for hassle-free cashless treatment.

Sixth Role

•  Maintaining service centre – Last but not the least function of TPA is to take care of a 24-hour full-fledged customer care centre where the policyholder can call and obtain their queries answered. Any queries associated with insurance , eligibility, claim settlement process, status associated with claim settlement, network hospitals, etc. are handled by these service centres. These service centres are often accessed from anywhere within the country.