Tied Up with the Following TPA’s
Many insurers have a tie-up with a TPA company. Health insurance companies can have a contract with
any one of these TPAs and the insurer's claims processing department would then be associated with the
contracted TPA, Among the TPAs, Health Insurance TPA of India is the one that caters solely to claims
relating to policies issued by public sector insurers. One can directly visit their website and find out the
network hospital providers and TPAs.
What is an in-house claims processing department?
In the in-house claim settlement process, instead of taking the services of a TPA company, insurers set
up an entire department within their own company to act as in-house claims processing department.
The in-house claims processing department is also known as HAT (Health Administration team).
A policyholder's health insurance claim can get settled by an insurer in two ways: third-party administrators
(TPA) and through the insurer's in-house claims processing department.
You should know that TPAs are available only for processing of health insurance claims, i.e., there are no
TPAs for other kinds of claims like life or motor. There are advantages as well as disadvantages of both
methods of claims processing.
What is a third-party administrator?
A TPA is basically a middle man who facilitates the settlement of a health insurance claim. A TPA is
appointed by the insurer. TPAs help you (the insured) process your health insurance claim using
various hospital bills and documents. However, they are not responsible for claims rejection or acceptance.
Many insurers have a tie-up with a TPA company. Ramani said that there are 26 companies in India
authorised by the Insurance Regulatory Development Authority of India (IRDAI) to act as TPAs. Health
insurance companies can have a contract with any one of these TPAs and the insurer's claims processing
department would then be associated with the contracted TPA, Ramani added.
Among the TPAs, Health Insurance TPA of India is the one that caters solely to claims relating to policies
issued by public sector insurers. One can directly visit their website and find out the network hospital
providers and TPAs.
What is an in-house claims processing department?
In the in-house claim settlement process, instead of taking the services of a TPA company, insurers
set up an entire department within their own company to act as in-house claims processing department.
The in-house claims processing department is also known as HAT (Health Administration team).
