InvestorQ : What are third-party administrators’ key responsibilities?
Shreya Mashelkar made post

What are third-party administrators’ key responsibilities?

3 years ago

Third-party administrators or TPAs are the main point of contact for policyholders whenever they need any aid for claim settlement.

They function as intermediaries between the insurance provider and the insured. The stakeholders involved in the entire insurance business are:

- Policyholders

- Insurance companies

- Healthcare providers

TPAs were introduced by the sector regulator IRDA in 2001 and handle various important aspects of insurance as listed below:

- Processing of claims and settlement

- Utilization review

- Provider network

- Enrolment

- Premium collection

- Cashless processing (if and when a policyholder is admitted to a listed hospital of an insurance provider, the latter pays the bill)

- Value-added services

- Database maintenance

The processing of claims and settlement for TPAs include:

o Accepting intimations

o Approving cashless claims

o Disbursing claims

TPAs offer the following value-added services:

o Ambulance services

o Specialised consultation

o Availability of beds

o 24-hour toll-free helplines

o Lifestyle management

o Wellbeing programmes

o Medicine supplies

o Health facilities

Experts are of the view that providing cashless hospitalization of the insured should be the primary service offered by TPAs. It is important to note that some insurance companies have a separate department which performs the functions of TPA instead of outsourcing it to another entity altogether.