Q. Who is a Third Party Administrator (TPA) & What are their functions?

A. An important link between Insurance companies policyholders & healthcare providers (Hospitals and nursing homes) is the Third Party Administrator (TPA). The TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.

The Unique Services offered by TPA for Healthcare Provider and policyholders.

1 Easy and Cashless Hospitalization: A list of empanelled hospitals where in he/she can avail cashless hospitalization is provided for each policyholder.
2. ID card: In order to validate their Identity at the time of admission the TPA provides ID cards to all their policy holders.
3. Claims Management: TPA administers & settles claims for hospitals & policyholders on behalf of insurance companies
4. 24 hours customers help line: Through its 24 hrs call center information the TPA provides assistance regarding policyholder’s data, provider network, claim status, benefits available with existing cardholder, etc and furnishes them 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
hospitalized.
• If you have fresh policy / first year policy or recently got your policy renewed check with your
TPA about your policy enrollment, failure of which can result in rejection of your cashless
authorization request.
• Medical insurance do not cover your OPD consultation / procedure / investigation done before being hospitalized.
• 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.

Role of the Insurance Help Desk

1. Only policyholder’s (Those who have medical insurance) can avail the cashless service from TPA.
2. Insurance Help Desk only helps the policyholders in getting cashless approval from TPA.

Plan for planned Hospitalization

Policyholder’s collect the preauthorization form from the Insurance help desk & after
Filling and signing by the concerned doctor, submit it back to the Insurance Helpdesk at least 3- 4 days prior to hospitalization.