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What is a Third-Party Administrator (TPA) in Health Insurance?

Team AckoDec 16, 2024

This article is about focussing solely on TPAs, their meaning, role, etc. so that you are acquainted with one component of health insurance and then move on to unravelling more to educate yourself and make informed decisions when it comes to buying and renewing health insurance policies. Read ahead to know more about Third-Party Administrators in health insurance.

Contents

What is a TPA?
What is a TPA in Health Insurance?
What is the Role of TPA in Health Insurance?
Benefits of Third-Party Administrators in Health Insurance for Policyholders:
How to Choose the Best Health Insurance TPA?
What Are the Risks Associated with TPA?
How to Cancel TPAs in Health Insurance:
List of Third-party Administrators for Health Insurance:
Conclusion
Frequently Asked Questions:

What is a TPA?

TPA, is the abbreviation for Third-party Administrator. As the name suggests, it is someone or some organization that is a third party and an administrator. This brings up the question: what is a third-party administrator? The simple answer is; someone who is not the first or the second party in a health insurance contract (not directly involved) and assists in the administrative aspect of the services mentioned in the contract.

For example, Health TPA is someone engaged in administering services related to health insurance.

What is a TPA in Health Insurance?

The scope of health insurance is a lot wider than other general insurance categories like vehicle or travel insurance. Due to this wide scope, health insurance involves a plethora of terminologies. This is the reason why probably potential and current policyholders perceive health insurance to be filled with complexities. From the outset, this does seem intricate, entangled, and maze-like. But it is simple to understand if you focus on one component at a time instead of getting overawed by the entirety of it. For example, not everyone might know about the concept of Third-party Administrators (TPA) in health insurance.

A TPA in health insurance is an entity that is a third party in a health insurance agreement and administers the claim settlement aspect of the contract between a policyholder and the insurer. Here are some points that will help you understand TPA in a better manner.

TPA is a link between the insurer and the insured in the case of a hospitalization claim.

TPA is chosen by the health insurance company.

TPA’s facilitate the claim settlement process by administrating tasks such as dealing with documents and settling hospital bills.

TPAs are licensed by the Insurance Regulatory and Development Authority of India (IRDAI).

Insurers associate with TPAs for a smooth claim settlement process.

One TPA can be associated with several insurers.

What is the Role of TPA in Health Insurance?

The following points will explain the role of TPA in medical insurance.

1) Connecting Link

Whenever there is a hospitalisation claim, the policyholder directly or indirectly meets the TPA. The TPA offers the ID card and a Unique Identification Number to the patient, which helps in claim settlement. Thus, the TPA is the link between the insurance company and the policyholder when it comes to availing the hospitalisation cover and processing claims.

2) Record Keeping

Crucial records related to the policyholder when admitted as a patient are maintained by the TPA. The records are stored in a dedicated database.

3) Claim Settlement

The role of a TPA is integral to the Cashless Claims settlement process. The coordination between the insurer and the hospital is crucial in a Cashless Claims process as the bill is settled directly between these two parties. The TPA offers back-end support in such situations.

4) Continuous Support

Several TPAs have a 24×7 support system where policyholders can raise their queries and get to know the answers seamlessly. Call centres and mobile applications help to offer such kind of support.

5) Empanel Hospitals

TPAs also perform duties related to hospital empanelment. They check whether the hospitals meet the set criteria concerning being a part of Network Hospitals (tie-ups for hassle-free claim settlement).

6) Extra Services

Some TPAs might also offer additional services related to ambulances, extra beds, medicine supply, etc. to the policyholder.

Benefits of Third-Party Administrators in Health Insurance for Policyholders:

The benefit of TPAs for the insurance company is obvious—they get assistance for settling claims. But how does a good health insurance TPA benefit the policyholders? The following points will let you know.

Hand-holding during hospitalization.
Providing ID cards to policyholders/patients.
Assistance regarding the right kind of documentation.
Efficient Cashless Claims settlement process.
24×7 customer support.

How to Choose the Best Health Insurance TPA?

Selecting the right TPA is crucial to ensuring a smooth claims experience and effective policy management. Begin by verifying the TPA’s credentials, including its license issued by the Insurance Regulatory and Development Authority of India (IRDAI). Assess the TPA’s network of empaneled hospitals to confirm that it includes quality medical facilities near you. Additionally, review the TPA’s track record in customer service, including claim settlement timelines and user satisfaction ratings. Always prioritize TPAs with robust data security measures to safeguard your personal information. While selecting the right TPA, it is important to check the IRDAI license of the company to ensure credibility. Also check their network of empaneled hospitals for accessible care. Review their track record in terms of claims settlement and their customer service. It is wise to prioritize the TPAs with strong data security and positive user reviews. Compare their services and ensure they handle claims promptly. After going through all the details, choose the one TPA with clear and transparent processes.

What Are the Risks Associated with TPA?

Engaging a Third-Party Administrator (TPA) in health insurance offers several benefits, but it also comes with certain risks that policyholders and insurers should be mindful of. One key risk involves potential delays in claim processing, as coordination between multiple entities—insurers, TPAs, and hospitals—can sometimes result in inefficiencies. Additionally, errors in documentation or miscommunication between parties can lead to claim rejections. Furthermore, policyholders might face challenges in maintaining confidentiality of sensitive medical records, as TPAs handle significant amounts of personal data.

While choosing a TPA or Third-Party Administrator in health insurance carries many benefits, it also comes with some risks. Such coordination problems between insurers, TPAs and hospitals sometimes delay the processing of claims. Several errors in communication and documentation errors can lead to claims being rejected, which is disappointing for the policyholder. Handling sensitive medical data by a TPA raises privacy concerns if appropriate security measures are not taken while handling it. It would help mitigate the above risks if a reliable TPA with a good track record on efficiency, transparency, and data protection is chosen.

How to Cancel TPAs in Health Insurance:

TPAs are facilitators. And if there is a time gap between the services being provided, you can contact your insurer and they will coordinate with the TPA and let you know about the progress. If you feel you want to cancel a TPA or switch to a different TPA, you can discuss such a change in service with your insurance company. Here are the steps concerning how to cancel the TPA in health insurance.

Step 1: Reach out to your insurer via call or email.

Step 2: Share policy details and unique ID (UID) if any.

Step 3: Explain the reason for TPA cancellation.

Step 4: If the insurer approves of the change, select another TPA from the available list.

List of Third-party Administrators for Health Insurance:

Here’s a detailed list of Third-party Administrators for health insurance that has been sourced from the Insurance Regulatory and Development Authority’s official website. Note that this information is mentioned for informational purposes only. Appropriate discretion and verification are advised.

No.	TPA	Registration No.	Registration Validity	Name & Address	Contact Details
1	United Health Care Parekh Insurance TPA Private Limited	No. 002	20.03.2023	Mr. Shiva BelavadiChief Executive Officer,3B/1 Gundecha Onclave, Kherani Road,Saki Naka, Andheri (East),Mumbai – 400 072	Toll Free No.: 1800 209 8884Email: [email protected] Website: www.uhcpindia.com
2	Medi Assist Insurance TPA Private Limited	No. 003	20.03.2023	Mr. Ganesh K Chief Administrative OfficerTower D, 4th Floor, IBC Knowledge Park, 4/1,Bannerghatta Road, Bangalore, 560029	Toll free number for senior citizens: 1800 419 9493Toll Free No.: 1800 425 9449Email: [email protected]: www.mediassist.in
3	MD India Health Insurance TPA Private Limited	No. 005	20.03.2023	Mr. Suresh V. KarandikarChief Executive OfficerS.No. 46/1 E-space A-2 Building,3rd Floor, Pune-Nagar Road,Vadgaonsheri, Pune – 411 014.	For senior citizens: 020-25300126Toll Free No.: 1800 233 1166Fax: 1860 233 4449Email: [email protected]: www.mdindiaonline.com
4	Paramount Health Services & Insurance TPA Private Limited	No. 006	20.03.2023	Dr. Nayan ShahChief Executive OfficerPlot No. A-442, Road No. 28, Ram Nagar,MIDC Industrial Area, Wagle Estate, Thane (W) – 400 604	Senior Citizen Helpline No.: 022 66629813Toll Free No.: 1800 22 66 55Email: [email protected] Website: www.paramounttpa.com
5	Heritage Health Insurance TPA Private Limited	No. 008	20.03.2023	Mr. Manash Chakraborty,Chief Administrative OfficerNICCO HOUSE, 5th Floor, 2, Hare Street,Kolkata-700001	Toll Free No.: 1800 345 3477Email: [email protected]: www.heritagehealthtpa.com
6	Family Health Plan Insurance TPA Limited	No. 013	20.03.2023	Ms. G. BharathammaChief Executive OfficerNo: 8-2-269/A/2-1 to 6, 2nd FloorSrinilaya Cyber Spazio, Road No. 2,Banjara Hills, Hyderabad – 500 034.	Senior Citizen Helpline No.: 1800 102 4273Toll Free No.: 1800 102 4033Email: [email protected]: www.fhpl.net
7	Raksha Health Insurance TPA Private Limited	No. 015	31.03.2023	Mr. Pawan Kumar BhallaChief Executive Officer C/o Escorts Corporate Centre 15/5, Mathura Road, Faridabad,Haryana – 121 003	Toll Free No.: 1800 180 1444, 1800 220 456, 1800 425 8910Email: [email protected] Website: www.rakshatpa.com
8	Vidal Health Insurance TPA Private Limited	No. 016	15.05.2023	Ms. Sudha Suhas Kulkarni Chief Administrative OfficerFirst Floor, Tower No. 2, SJR iPark, EPIP Zone, Whitefield, Bangalore – 560 066.	Toll Free No.: 1860 425 0251, 080 46267018Email: [email protected]: www.vidalhealthtpa.com
9	East West Assist Insurance TPA Private Limited	No. 018	15.05.2023	Dr. Atul AroraChief Executive Officer38, Golf Links, New Delhi – 110003	Ph. No.: 011-47222666 FAX: 011-47222640 Email: [email protected]: www.eastwestassist.com
10	Medsave Health Insurance TPA Limited	No. 019	14.05.2023	Mr. S. AravamuthanChief Administrative OfficerF-701A, Lado Sarai, Mehrauli, New Delhi – 110030	Senior Citizen Helpline No.: 9319810070Toll Free No.: 1800 111 142Email: [email protected] Website: www.medsave.in
11	Genins India Insurance TPA Limited	No. 020	10.06.2023	Mr. Subhash Chander Khanna,Chief Administrative OfficerD-34, Ground Floor, Sector-2Noida – 201301 (U.P.)	Toll Free No.: 1800 345 3323Ph. No.: 0120-4144100 Fax:0120-4144170-71Email: [email protected]: www.geninsindia.com
12	Alankit Insurance TPA Limited	No. 021	17.11.2020	Mr Bodh Raj PunjDirector & Chief Executive Officer Alankit House, 4E/2,Jhandewalan Extension, New Delhi – 110055	Toll Free No.: 1800 11 3300Ph. No.: 011-42541621-24 Fax:011-42541620-30Email: [email protected]: www.alankithealthcare.com
13	Health India Insurance TPA Services Private Limited	No. 022	17.11.2020	Mr. Kamaljeet GuptaChief Administrative OfficerNeelkanth Corporate Park, Office No. 406 to 412,4th Floor, Kirol Road/Village, Vidya Vihar Society,Vidya Vihar (West), Mumbai-400086	Senior Citizen Toll Free No.: 1800 2269 70Toll Free No.: 1800 2201 02Ph. No.: 022-40881000Email: [email protected]: www.healthindiatpa.com
14	Good Health Insurance TPA Limited	No. 023	26.01.2021	Ms. Saigeeta Dikshit,Chief Administrative OfficerSuite 403 – 406A, 4th Floor, Ashoka My Home Chambers,Behind Ashok Bhoopal Chambers, Sardar Patel Road,Secunderabad, Telangana State – 500003	Senior Citizen Toll Free No.: 1800 102 9919Toll Free No.: 1860 425 3232Email: [email protected] Website: www.ghpltpa.com
15	Vipul Medcorp Insurance TPA Private Limited	No. 024	28.02.2022	Mr. Rajan SubramaniamChief Executive Officer515, Udyog Vihar, Phase 5,Gurgaon, Haryana – 122 016	Senior Citizen Toll Free No.: 1800 120 3348Toll Free No.: 1800 108 7477, 1800 102 7477Ph. No.: 0124-4833900 Fax: 0124-4699611Email: [email protected]: www.vipulmedcorp.com
16	Park Mediclaim Insurance TPA Private Limited	No. 025	27.09.2022	Mr. Anurag BhatnagarChief Executive Officer702, Vikrant Tower,Rajindra Place,New Delhi-110008	Toll Free No.: 1800 11 55 33Ph. No.: 011-43191000Email: [email protected]: www.parkmediclaim.co.in
17	Safeway Insurance TPA Private Limited	No. 026	19.07.2020	Mr. Mahesh SharmaChief Executive Officer815, Vishwa Sadan, District Centre,Janakpuri, New Delhi-110058	Toll Free No.: 1800 102 5671Ph. No.: 011-45451300Email: [email protected]: www.safewaytpa.in
18	Anmol Medicare Insurance TPA Limited	No. 027	26.10.2020	Mr. P. S. KshatriyaChief Executive Officer2nd Floor, NBCC House, Opp. Ahmedabad Stock Exchange,Ambavadi, Ahmedabad – 380015, Gujarat	Toll Free No.: 1800 233 1999Ph. No.: +91-79-61609926, 61609930E-mail: [email protected]: www.anmolmedicare.in
19	Grand Insurance TPA Private Limited	No. 029	15.05.2021	Mr Bibhutosh ChattopadhyayChief Administrative OfficerGrand House, 45A,Hindustan Park,Kolkata 700 029 (West Bengal)	Toll Free No.: 1800 102 4747Ph. No.: 033-40274747 Fax: 033-40043344Email: [email protected]: www.grandtpa.co.in
20	Rothshield Insurance TPA Limited	No. 030	15.07.2022	Ms. Janki M BhateChief Executive Officer402, Raheja Chambers,Nariman Point,Mumbai 400 021	Toll Free No.: 1800 228 144Ph. No.: 022-22048144 Fax: 022-22854415Email: [email protected]: www.rothshield.co.in
21	Ericson Insurance TPA Private Limited	No. 035	18.12.2021	Dr. Krishna P. Jaiswal, MD11-C, Corporate Park,ST Road, Chembur,Mumbai – 400 071 (Maharashtra)	Senior Citizen Helpline No.: 022-25280208Toll Free No.: 1800 22 2034Ph. No.: 022-25280280Email: [email protected]: www.ericsontpa.com
22	Health Insurance TPA of India Limited	No. 036	05.06.2023	Mr. SK MehraChief Executive Officer2nd Floor, Majestic Omnia Building,A-110, Sector-4, Noida 201301 (Uttar Pradesh)	Toll Free No.: 1800 180 3600, 1800 102 3600Email: [email protected]: www.hitpa.co.in
23	Vision Digital Insurance TPA Private Limited	No. 037	24.06.2021	Ms. Priyanka JainChief Administrative OfficerTime Square Building 3rd & 4th Floor,Sushant Lok-1, Block-B,Gurugram – 122002	Toll free no: 1800-419-9982Ph. No.: 0124-4003171Email: [email protected]: www.visiontpa.in

Conclusion

Third-Party Administrators (TPAs) make health insurance easier to navigate by handling claim settlements and providing support when it’s needed most. They connect insurers, policyholders, and healthcare providers, simplifying what can often feel like a complicated process. However, it’s important to choose a TPA carefully—look into their reputation, hospital networks, and service quality to avoid issues like delays or data concerns. Picking the right TPA can make your health insurance experience smoother and more reliable.

Frequently Asked Questions:

Here are some of the prominent frequently asked questions related to TPA in health insurance. If you have specific queries, you can send an email at [email protected].

Do I have to pay money to the TPA?

You do not have to pay money to the TPA as you must deal directly with the insurance company.

Do I get a say in selecting a TPA?

Recent reports suggest that policyholders might have the option to select their Third-Party Administrator (TPA). To confirm if this applies to your policy, reach out to your insurance company for clarification and guidance.

What kind of individuals are there in the TPA’s team?

The TPA team can consist of experts belonging to the following fields: doctors, insurance consultants, legal experts, Informational Technology (IT) professionals, etc.

Who hires the TPA?

The TPA is hired by the health insurance company to assist in the claim processing process.

Can a TPA help in reducing fake claims?

Yes, TPA’s services can help the insurance company to reduce the instances of fake claims.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.