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A Third Party administration, or TPA, is a company that has been authorised by India’s Insurance Regulatory and Development Authority (IRDAI). Having a Third Party Administrator License is required for businesses. A third-party administrator aids in processing insurance claims for business and retail insurance. In addition to this, the TPA serves as an insurance company outsourcing entity.
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The Insurance Regulatory and Development Authority of India (IRDAI) has granted a licence to an organisation known as a Third Party Administrator (TPA) to process health insurance claims. TPAs serve as a middleman between the insured and an insurance company. Therefore, insurance companies, policyholders, and healthcare providers are the parties.
For the purpose of serving as the policyholder’s administrator, a TPA license is necessary. In order to assist the policyholder in resolving insurance claims, health insurance firms (both life and health insurance) engage third-party administrators. To resolve insurance claims, third-party administrators analyse policyholders’ medical records and hospital bills. Insurance claims are not subjected to approval or denial by Third Party Administrators.
Some of the most crucial facets of health insurance are handled by TPAs. Processing health insurance claims (accepting requests, approving cashless claims, and disbursing the claims) is just one of them. Others include provider network, utilisation review, enrollment, premium collection, cashless processing (if the treatment is received at a network hospital), value-added services like ambulance services, availability of beds, specialised consultation, wellbeing programmes, medicine supplies, 24-hour toll-free helplines, lifestyle management, and health facilities.
The Insurance Regulatory and Development Authority of India is the principal regulatory body in relation to the Third Party Administrator License (IRDAI). The Insurance Act of 1938[1] and the Insurance Regulatory and Development Authority Act of 1999 are the two pieces of legislation that support the Third Party Administrator License. The Insurance Regulatory and Development Authority of India (Third Party Administrators – Health Services) Regulations, 2016, is the primary regulation.
To obtain a third party administrator license, the applicant has the fulfil the following:
The application procedure for the grant of a certificate of registration is as follows:
The authority must consider all factors related to the operation of TPA’s business when evaluating the submission for a certificate of registration.
The third-party administrator will be given a certificate of registration that is valid for three years. The authorities or the applicant have the right to revoke, cancel or suspend the validity of the certificate of registration.
From the understanding of the requirements mentioned above and the work of Third Party Administrator, You can get TPA’s help when needed. If you recently purchased a health insurance plan and are having trouble filing a claim. You can enlist the aid of third party administrators and get the benefits of their services to handle your health insurance claim quickly and affordably.
Also Read: Increasing InsurTech Opportunities for Insurers
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