You’ve got a health claim and you don’t know how to go about it? There are unseen agencies who help us indirectly in settling our health claim. Let us know more about them.
What is a TPA?
Pillars are the foundation of any building. Likewise TPA’ (Third Party Administrator) is the pillar of health insurance companies. Not many of us know that behind every health claim there is a great team which helps us with stress free claims.
We buy health insurance policies to ease some burden off our shoulders. It not only helps us financially, but also gives a major peace of mind. I am sure we are all aware of the benefits of having a health insurance policy. However, we go clueless when a health claim arises!
Hence, a special agency was set by the IRDAI in 2001 to help insurance companies in claim assistance. This agency or company helps in claim assistance and other activities on behalf of the insurer. This agency/ company is called as a ‘Third Party Administrator’ commonly known as TPA.
How Does a TPA work?
TPAs are IRDAI-licensed third-party entities who provide management solutions to health insurance companies. They act as an intermediary between the insurance company and policyholder to ensure that cashless claims and reimbursement claims are settled smoothly. When a policyholder requires medical treatment, the individual will get in touch with the TPA of the insurance company. The TPA will let the client know about the nearest network hospital and help him or her with the claim process. At the time of discharge, all of the medical bills will be sent to TPA for payment. The TPA will scrutinize the medical bills, verifying them against the pre-negotiated rates. Once all of the documents and bills are approved, then the expenses will be settled directly or reimbursed by the company.
Third Party Administrator and Its Role in Health
The third party administrator or the TPA holds license from the IRDAI to process claims and cashless facilities to the insurer. They act as an intermediary between the insurance provider and the insured. Let’s see how they provide assistance.
- Claim settlement
- Processing of cashless claims
- Providing list of network hospitals
- Online pre-authorization with hospital
- Tracking claims
- Ambulance services
- 24 hour toll free helplines
- Other health facilities
Need for TPA
- Immense knowledge of health care services
- Better quality of services
- Proper management and investigation of cases
- Adhering to the Cashless and reimbursement TAT’s
Since the TPA is directly in touch with the insurance company, brokers etc, processing of claims and other duties will be done by TPA and Insurers and brokers will be one point of contact for them. Let’s see how they provide assistance.
During health claims :TPA will assist at the time of a medical emergency and you can rely on them completely as they will look after the payment of bills of your hospital i.e. cashless settlement.
Authenticity of claims: As per IRDAI regulations, they have their own team of doctors, legal experts, insurance consultants who study the case in depth and ensure there are no fake claims.
Hospital Network: They are also responsible in building hospital networks for cashless claims and negotiating rates with hospitals.
List of TPA’s in India
|Name of the TPA||Name of CAO/CEO / Address||Contact Details|
|United Health Care Parekh Insurance TPA Private Limited||Mr. Shiva Belavadi Chief Executive Officer, 3A Gundecha Enclave, Kherani Road, Saki Naka, Andheri (East), Mumbai – 400 072||Phone: 022-28532400 Fax : 022-2852 7776 E mail: email@example.com|
|Medi Assist Insurance TPA Private Limited||Mr. Ganesh K Chief Administrative Officer Tower D, 4th Floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore, 560026||Phone :+91 80 49698036 Toll Free Fax No.: 1800 425 9559 Email: firstname.lastname@example.org; email@example.com Web:www.mediassistindia.com|
|MDIndia Health Insurance TPA Private Limited||Mr. Suresh V. Karandikar Chief Executive Officer S.No. 46/1 E-space A-2 Building, 3rd Floor, Pune-Nagar Road, Vadgaonsheri, Pune – 411 014.||020-25300000 firstname.lastname@example.org Fax : 020-25300003 web:www.mdindiaonline.com|
|Paramount Health Services & Insurance TPA Private Limited||Mr. R D Misra Chief Administrative Officer, Plot No. A-442, Raod No. 28, MIDC Industrial Area, Wagle Estate, Ram Nagar,Near Vitthal Rukhmani Mandir, Thane (W), MS - 400 604.||022-6644 4600/6662 0800 Fax : 022-66444754/755 email@example.com Web:www.paramounttpa.com.|
|E-Meditek Insurance TPA Limited||Dr.Dhiraj Kumar Singh Chief Administrative Officer, 577, Udyog Vihar, Phase – V Gurgaon - 122016 (Haryana)||Ph : 0124-4466600 Fax : 0124-4466677 firstname.lastname@example.org email@example.com Toll free: 1800113242|
|Heritage Health Insurance TPA Private Limited||Mr. Surendra Kumar Tiwari, CAO, NICCO HOUSE ( 5th Floor) 2, Hare Street Kolkata-700001||Phones: 033-22482784, 22486430, Fax: 033-22100837/ 22310287 e-mail: firstname.lastname@example.org Toll free 1088-345-3477|
|Focus Health Insurance (TPA) Private Limited||Mr.Hari Venkatraman Chief Executive Officer, Focus Healthcare Private Limited, B-127, FIRST FLOOR, SECTOR-2, NOIDA - 201301||Phone no. 0120-4881400 email@example.com Toll free no. 1800 112 999 web:www.focustpa.com e-mail: firstname.lastname@example.org|
|Medicare Insurance TPA Services (India) Private Limited||Shri. Dipankar Roy Chief Administrative Officer Flat No 10, Paul Mansions , 6B, Bishop Lefroy Road, Kolkata - 700 020.||033-2281 2826, 9831184120 2280 9510/ 2280 9791 Fax-033-2280 6111 Email :email@example.com|
|Family Health Plan Insurance TPA Limited||Ms. G. Bharathamma Chief Administrative Officer M/s Family Health Plan Ltd. Ground Floor, F1, Srinilaya, Cyber Spazio, Road No. 02, Banjara Hills, Hyderabad – 500 034.||040-23556464 firstname.lastname@example.org Fax : 040-23541400|
|Raksha Health Insurance TPA Private Limited||Mr. Pawan Bhalla Chief Executive Officer C/o Escorts Corporate Centre , 15/5, Mathura Road, Faridabad, Haryana – 121 003||0129-2564057, 2564083, 2250000 email@example.com firstname.lastname@example.org Fax: 0129-4018012/ 2250002|
|Vidal Health Insurance TPA Private Limited||Ms. Sudha Suhas Kulkarni Chief Administrative Officer, Tower 2, 1st floor, SJR I Park, Plot No. 13,14,15, EPIP Zone, Whitefield, Bangalore - 560 066.||080-40125678 email@example.com Fax : 080-28418216/17 Toll free: 1800 345 4051|
|Anyuta Insuance TPA In Health Care Private Limited||Ms. Ratna Seetarama Chief Administrative Officer, No.: 31/18, Main Road, Loyola Layout, Ward No. 111, Shanthala Town, Bangalore - 560 047.||Landline / Fax : 080-41128311 / 25364766 firstname.lastname@example.org, email@example.com website:www.anyutatpa.com|
|East West Assist Insurance TPA Private Limited||Mr. Neeraj Batra Chief Executive Officer 404 & 602 DLF Place, saket, 4th Floor, Mall Office Block, District Centre, Saket, New Delhi - 110017||011-47222666 FAX: 011-47222640 firstname.lastname@example.org email@example.com Toll free no. 1800-1111-46|
|Medsave Health Insurance TPA Limited||Mr. Vivek Tiwari Chief Executive Officer F-701A, Lado Sarai, Behind Golf Course, Mehrauli New Delhi – 110 030||011-29521061-66, 39001234 Fax – 29521067/71 Email: firstname.lastname@example.org Website:www.medsave.in|
|Genins India Insurance TPA Limited||Mr. Subhash Chander Khanna, Chief Administrative Officer D-34, Ground Floor, Sector-2 NOIDA-201301||0120- 4144 123 (10 lines) Fax -4144 170/ 171 email@example.com Fax : 0120-2430064 Toll free no.-1600-345-3323|
|Alankit Insurance TPA Limited||Sudhir Kumar Malhotra Director & Chief Administrative Officer Flat Nos.201, Second Floor, Vikas Surya Mall , Sector-3, Rohini -NEW DELHI - 110 085||011-49355621 to 49655627 firstname.lastname@example.org Fax : 011-49355620 & 49355630|
|Health India Insurance TPA Services Private Limited||Mr. Kamaljeet Gupta CAO and Joint MD Anand Commercial Co. Compound, 103-B L B S Marg, Gandhi Nagar, Vikhroli ) Mumbai 83||022-42471900 (80 lines) fax 022-42471910/911/946, 25783382 e-mail: email@example.com|
|Good Health Insurance TPA Limited||Ms. Saigeeta Dikshit, Chief Administrative Officer, 8-2-1/8/1, S.V.R. Towers, 4th Floor, Srinagar Colony Road, Panjagutta Hyderabad – 500 082.||040 – 66825001/003, 23735006 Fax : 040-66828081/88 /89 e-mail: firstname.lastname@example.org|
|Vipul Medcorp Insurance TPA Private Limited||Mr. Rajan Subramaniam Chief Executive Officer, 515, Udyog Vihar, Phase V, Gurgaon – 122 016||Ph : 0124-2438270-75 Fax: 0124- 2438276 e-mail: email@example.com|
|Park Mediclaim Insurance TPA Private Limited||Sh Girish Verma Chief Executive Officer 702, Vikrant Tower Rajendra Place New Delhi-110008||Tel: 4153 9498 (4 lines) 25747454-55 Fax: 41539390-91 Email : firstname.lastname@example.org / Website:www.parkmediclaim.com|
|Safeway Insurance TPA Private Limited||Mr. Mahesh Sharma , CEO 815, Vishwasadan, District Centre, Janakpuri, New Delhi-1100058||Website:www.parkmediclaim.com Tel.: 011-4142 5671, 25464823 Fax.: 011-41425672/912266466797 E-mail: email@example.com firstname.lastname@example.org Website:www.safewaymediclaim.com|
|Anmol Medicare Insurance TPA Limited||Mr P. S. Kshatriya Chief Executive Officer No. 3, 2nd Floor, NBCC House, Near Shajanand College, Opp. Stock Exchange, Ambavadi, Ahmedabad – 380015, Gujarat||Tel.: 079-40009926, 40009936, 40009999 Fax.: 079-40009990 E-mail: email@example.com|
|Dedicated Healthcare Services TPA (India) Private Limited||Ms. Anahita Daver, Chief Administrative Officer, Cambata Building, (Eros Theatre Building) East Wing, 2nd Floor, 42 Maharishi Karve Road, Mumbai 400 020. Maharashtra||Tel: 022-22875052 Toll free number 16 00 22 0201 Fax number: 022- 2287 4235 Tel: 022-66275900 Toll Free 18002090201 Fax No. 022-22874235 Email: firstname.lastname@example.org email@example.com Website:www.dhs-india.com|
|Grand Insurance TPA Private Limited||Mr Bibhutosh Chattopadhyay Chief Administrative Officer 45A Hindustan Park, P.S.: Garighat Kolkata 700 029 West Bengal||Tel: 033- 40274747 Mobile number: 9830063492 / 9051288050 Toll Free number 1800 102 4747 Fax Number 033-400433344 E-mail- firstname.lastname@example.org / email@example.com|
|Rothshield Insurance TPA Limited||Ms. Janki M Bhate Chief Executive Officer, 402 Raheja Chambers, Nariman Point, Mumbai 400 020||Tel: 022- 2202 2147/22048144 Fax Number 022-2285 4415/ 39167430 E-mail- firstname.lastname@example.org WEB:www.rothshield.co.in Toll free: 1800 22 8144|
|Ericson Insurance TPA Private Limited||Dr. Krishna P. Jaiswal, MD Ericson TPA Healthcare Pvt. Ltd. 4th Floor, New Vijay Cinema Building S.T.Road, Chembur Mumbai - 400 071 (MH)||Phone 022 - 25280280 E-mail: email@example.com Toll Free line: Toll Free FAX:|
|Health Insurance TPA of India Limited||Smt M Malti Jaswal, CAO Health Insurance TPA of India Limited 2nd Floor,Majestic Omnia Building, A-110,||Phone: 0120-4765800 Fax: 0120-4765899 firstname.lastname@example.org|
Hence, TPA’s are now the backbone of any insurance company since they have undertaken major responsibilities on behalf of the insurance company.
Common Faqs On TPA
What is a Third-Party Administrator for Employee Health Benefits?
A TPA for employee health benefits is an organization that undertakes administrative services, like record-keeping and claims processing, generally on behalf of an employer who provides health care benefits to its employees. Most employers normally finance the healthcare costs of their employees by contracting with a TPA, who administers the many aspects of a self-funded health plan.
Why do Health Insurance Companies need TPAs?
When one takes into consideration the diversity of health insurance policies and the complexities of providing service of a consistently high quality, it is quite evident why TPAs are necessary. They are professional organisations who are able to manage the myriad operations of health insurance sector. TPAs are outsourced entities who are licenced by the insurance regulator to provide management solutions to the sector.