TPA Department In Krush Divine Hospital

What is TPA in Health Insurance?

Ever faced a situation for an emergency hospitalization of any dear one? Though bitter but it is a hard and unavoidable factor of our life. At the time of accidental happenings or mishaps that need immediate hospital care, you rush for medical aid. Those who have an insurance policy can breathe a bit but those who don’t can face a financial crisis. We have insurance companies to buy a health insurance cover. But we have a TPA i.e. a Third Party Administrator to fix problems related to the health insurance claims. So as soon as any individual is admitted to the hospital an intimation of the same is given to the TPA. For you to understand the role and application of a TPA, let us gather some more insights about it.

What is the Role of TPA in Health Insurance?

A TPA plays a vital role in the total processing of health insurance claims. In the practical world of insurance, some of the jobs of a TPA may refer to the following kind: Issue the Health Cards to the insured For every policy issued to the policyholder, a validation procedure is carried. It is accomplished by issuing an authorized health card. This card holds the detail of the policy number and the TPA which is held responsible for claims processing. At the time of admission to the hospital, the insured can produce this card and intimate the occurrence of the claim either to the insurer or TPA. It is one of the essential documents needed for claim processing. Smooth Claim Processing and Settlement A TPA is responsible to expedite the claim as soon as it is intimated by the insured. Their job is to check all the documents submitted in favor of the claim. It can ask for as much information as is needed to cross verify the details. The settlement of the claim will either be on cashless or on a reimbursement basis. Whichever be the case, a TPA will be liable to check for all documents. In the case of Cashless, the TPA can collect the documents from the hospital. In other cases, the TPA can ask for the supporting papers and bills from the policyholder. Arrange for Value-Added Services Other than the claim processing and card issuance, a TPA also arranges for other services like ambulance, well-being programs, and others.