TPA Full Form

What is the full for of TPA?

TPA is an abbreviation for Third Party Administrator. Unlike insurance brokers that act on behalf of our business, a TPA acts on behalf of the insurance company. Businesses hire TPAs to collect premiums, handle enrollment, administer claims, and carry out other activities related to claims and benefit plans ( flexible spending accounts, retirement plans, etc.).

This Story also Contains

1. What is the full for of TPA?
2. WHO IS TPA?
3. What Services Do TPAs Provide?
4. Advantages Of TPA
5. What Is The Role Of TPA In Health Insurance?
6. How Does TPA Help Policyholders?
7. LIST OF TPA Insurance Companies

WHO IS TPA?

TPA is the agent of the insurance company and acts as a mediator between the insurance provider & the insured person. TPA holds a licence from the Insurance Regulatory Development Authority (IRDA) to process claims - corporate and retail policies in addition to giving cashless facilities as an outsourcing entity of an insurance company. A TPA is appointed by the insurer.

What Services Do TPAs Provide?

The services given by a TPA may span a broad spectrum and can frequently be customised. As in many industries, one can modify their agreement to match their requirements. TPA services can include:

• Health benefits reporting and analytics: A TPA that reports on our health program’s networks and point solutions should give regular and reliable reporting on claims, members, and other metrics associated with our self-funded plan.

• Adjudicating claims: A TPA can adjudicate whether claims are reimbursable under the policy and take care of processing member claims for one's business.

• Healthcare provider network access: A TPA can help to connect our self-funded plan to trusted healthcare provider networks.

• Detailed healthcare expense reporting: Gain access to additional detailed healthcare expense data without compromising employee secrecy. A TPA can provide you with reports to better understand healthcare expenses.

• Supporting stop-loss coverage by working with insurers.

• Consolidating payments for providers: A self-funded proposal may get services from multiple providers. A TPA may be able to promote making payments to these service providers, thus streamlining your administrative lift.

• TPA also Works with brokers and health insurance consultants.

Advantages Of TPA

TPA helps both the insurer and the insured. Here are a few of its major advantages.

• Greater efficiency or quality connected with the delivery of services.

• Higher provision for health insurance

• Streamline Inquiry removes delays

• Low insurance premiums

• Deals with all circumstances linked to claim settlements

• Gives a 24/7 toll-free number

• It does not accept false claims and tracks potential fraud by private health centres.

What Is The Role Of TPA In Health Insurance?

The role of TPA in health insurance can be understood by the following points:

• The link between insurance company and policyholder: In most hospitalisation claim cases, the policyholder directly or indirectly meets the TPA. The TPA gives the policyholder a unique Identification Number and ID card which support claim settlement.

• Record maintenance: TPA assists in maintaining important records related to policyholders when they are admitted as patients.

• Claim settlement: TPA ensures smooth coordination between the hospital and insurance company during cashless claim settlement. In such cases, back-end support is offered by TPA.

• Most of the TPAs have a 24x7 customer support system where the policyholders can put up their queries and receive feedback.

• Additional services: Most of the TPA also provide extra services like extra beds, ambulances, medical supplies, etc. to policyholders.

How Does TPA Help Policyholders?

We know that a TPA is an intermediary between the insurance company and the policyholder who simplify the claim procedure under health insurance policies. As we know there can be two types of claims: a) Cashless and b) Reimbursement.

As soon as there is a need for medical or emergency treatment, the policyholder visits a hospital. If the individual is asked for hospitalisation for a minimum of 24 hours (unless otherwise listed diseases like cataracts) a claim becomes acceptable.

The policyholder, in this case, will intimate the TPA or the insurer about the admission and the necessity for the treatment. The TPA will then ask the hospital to arrange for a cashless facility, if possible. Otherwise, the claim will be processed for compensation. After the treatment gets over, the hospital will send all the bills to the TPA if cashless is approved. If not, then the policyholder will have to submit the documents later.

The authorities at the TPA will scrutinise the bills and other papers post which the settlement of the claim will be allowed. In the case of cashless, the payment will be made to the hospital. But for the compensation, the expenses will be received by the policyholder via the insurance company.

LIST OF TPA Insurance Companies