TPA Full Form

TPA full form is Third Party Administrator. The TPA is an agency that works as a representative of insurance companies providing health insurance. It acts as an intermediary between the insurance company and the person having insurance. Its main function is to provide cashless treatment and reimbursement related to hospitalization and other medical expenses.

What is the Full Form of TPA?

As mentioned above the full form of TPA is Third Party Administrator. The TPA works as an agent who works for insurance companies for providing health insurance to individuals and acts as the mediator between the insurance-providing company and the person holding the insurance. TPA has a license from the IRDA, full form of which is Insurance Regulatory Development Authority since 2001 which helps in processing claims for institutions and other retail policies for providing cashless facilities during the treatment. The TPAs are issued by insurance companies. TPA also offers some value-added services such as hospital beds, easy and quick access to ambulances, 24/7 assistance, pharmacy services, and more.

How do People Get Benefitted From TPA?

1. Provides Cashless Claims

If the insured person gets admitted into the hospital & stays in the hospital for more than 24 hours, they can apply for a cashless payment as per the terms and conditions. TPA collects relevant information from the hospital and covers all costs or expenses that are paid or taken care of by the health insurance providing company.

2. Provides Assistance with Hospitalisation

The TPA provides health cards to insurance holders which allows families of patients to use health facilities in the insurance company's hospital network. They can also provide counseling, emergency, and rescue services to facilitate policyholders' hospitalization which helps in simplifying the process of admitting the patient. 

3. Reduces Claim Processing Time

The addition of TPA in the insurance business has improved in providing quality of services provided by insurance companies. As they have reduced the insurance company's workload which helped in reducing the processing time of claims and payments.

4. Improved Standardization 

TPA meets the needs of multiple hospitals and insurance organizations that have fixed procedures to assist their clients.

What are the Important Roles of TPA

The TPA plays a crucial role in the processing of medical claims. Below mentioned are some important roles of TPA:

1. Provides health cards

TPAs issue policyholders a health card which includes all details required to process applications, such as the policy number and name of the TPA. You can easily show your health card at check-in and your application can be easily approved and the claim will be provided. 

2. Provides smooth settlements for claims 

The primary role of the TPA is to manage the claims process of insurance companies and hospitals. They check all fees and documents submitted by applicants and cross-check all details before agreeing to a settlement.

3. Provide 24/7 assistance 

Generally, all TPAs provides  24/7 assistance to all policyholders that help individuals to easily access help and get answers/solution during emergencies.

4. Provides a vast network of hospitals

TPA has built a strong network of hospitals that provides cashless treatment. The policyholder can receive their treatment at any of the hospitals that are partnered with TPA. 

5. Maintains all claim records  

The TPA also collects and maintains records of claims and other claim-related information every year, which helps the insurance company track each settlement.

Documents Required to Claim Insurance

Below listed are the documents which are required to claim TPA health insurance 

• AAdhaar Card
• Copy of insurance
• TPA Card
• Original prescription of doctor 
• Pharmacy bill or receipt and hospital discharge documents 

What is the Difference Between TPA and Insurance Provider?

Third-party administrators are designed to manage the different types of services provided by insurance companies. Some examples of TPA include a smooth and streamlined application process, excellent customer service, and invoice management. TPA's primary role in health insurance is to bridge the gap between the insured and the insurance company. On the other hand, insurance providers are responsible for providing the best health insurance plans to individuals, groups, families, and others. In health insurance, the TPA acts is the central regulator of the health insurance system.

What are the Advantages of TPA?

TPA helps insurers & insured both by proving its benefits. Below mentioned are the advantages of TPA  

• They provide better performance along with providing good delivery of services.
• They provide higher and better provisions for insurance in the health sector. 
• They provide simple and easy solutions to issues which helps in eliminating delays in the treatment process. 
• They have low premiums compared to others.
• They provide complete solutions regarding any health matters and claim settlements. 
• They have a 24/7 toll-free number 

What is the Fee Structure for TPA?

Popular TPA-providing companies

Below listed are some popular companies which provide TPA health insurance 

• Medi Assist India TPA Pvt. Ltd
• Raksha TPA Pvt. Ltd
• Good Health TPA Services Ltd.
• Vidal Health TPA Pvt. Ltd
• Paramount Health Services & Insurance TPA Pvt. Ltd
• Focus Healthservices TPA Pvt. Ltd

Written By:

Deepit Mathur