TPA is an abbreviation of Third Party Administrator that provide cashless medical services.

They also
provide the necessary information to deal with any problem regarding claims

What is TPA ?
TPA means Third Party Administrators
who are licensed by The Govt. Of India
through IRDA to act as Insurance
Intermediary to provide services of health
care management on behalf of any
Insurance Company in India or any
department under any State of Central
Govt. who provides insurance cover,
within the terms conditions and
exclusions expressed in a contract of
insurance usually called as Mediclaim
Policy, issued to general public by such
insurance company, by interacting with
Health Care Providers such as Hospitals
Nursing Homes or any establishment set
up to cater to the medical needs of the
insuring public, for an agreed fee as
remuneration for such services.
What is TPA?
TPA stands for Third
Party Administrator. A
TPA is a specialized
health service provider
rendering variety of
services like networking
with hospitals, arranging
for hospitalization and
claim processing and
settlement. The concept
of TPA has been
introduced by the IRDA
(Insurance Regulatory
and Development
Authority of India) for the
benefit of both the
insured and the insurer.
While the insured is
benefited by quicker &
better health service,
insurers are benefited by
reduction in their
administrative costs,
fraudulent claims and
ultimately bringing down
the claim ratios. An
insurance company can
have more than one
TPA and a TPA can
serve more than one
insurance company.

Job of the TPA

 Policy collection from Branch office and Divisional office of the insurance companies.
To maintain the database of policyholders and issue the photo Identity card with unique number and
guide book.
24-hour toll-free phone number, which can be accessed from anywhere in the country.
Hospital empanellement to provide the cashless facility or pre hospitalization.
Handling the Cashless and Re-imbursement claims. 
I ssue the payment to insured/hospital against the claims

What is TPA?

TPA or the THIRD PARTY ADMINISTRATOR is a company licensed by IRDA (Insurance

Regulatory and Development Authority) to offer health claim related services for the benefit of
both the insured and the insurer. While the insured is benefited by quicker & better service,
insurers are benefited by reduction in their administrative costs, fraudulent claims and control on
claims.

In brief, the job of the TPA is to maintain databases of policyholders and issue them health
identity cards with unique identification numbers and handle all claim related issues including
claim settlements. In terms of infrastructure, the TPA will provide a 24-hour toll-free number,
which can be accessed from anywhere in the country. TPA will have full-time medical
practitioners under their employment who will immediately take a decision on whether the
ailment is covered under the policy or not on receipt of a cashless preauthorization request.

What are the scope of services of TPAs?

The scope of services of TPAs include:
Maintain database of policyholders
Issue of identity card to all policyholders
Provide ambulance service
Provide information to policyholders about hospitals.
Check various investigations
 Provide Cashless service
Process claims

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Who can become a TPA?

According to the Insurance Regulatory Development Authority (IRDA) regulation,
A company with a share capital and registered under the Companies Act, 1956 can function as a TPA.
The minimum paid up capital of the company shall be in equity shares amounting to Rs 1 crore. The
working capital should not be less than Rs 1 crore at any point of time.
At least one of the directors of the TPA shall be a qualified medical doctor registered with the Medical
Council of India.
The aggregate holdings of equity shares by a foreign company shall not exceed 26% of the paid up
equity capital of a TPA.

Scope of TPA

The scope of services will include:

 Issue of Identity card to all policyholders.

 Provide information to policyholders about hospitals.
 Provide Cashless access in TPA network hospitals.
 Process claims.
 Provide 24 hours, 7 days a week customer service toll free number.