TPA or the THIRD PARTY ADMINISTRATOR is a company licensed by IRDA (Insurance Regulatory and Development Authority) to offer health claim related services for the benefit of both the insured and the insurer. While the insured is benefited by quicker & better service, insurers are benefited by reduction in their administrative costs, fraudulent claims and control on claims.
In brief, the job of the TPA is to maintain databases of policyholders and issue them health identity cards with unique identification numbers and handle all claim related issues including claim settlements. In terms of infrastructure, the TPA will provide a 24-hour toll-free number, which can be accessed from anywhere in the country. TPA will have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy or not on receipt of a cashless preauthorization request.
The scope of services will include: