The Role of a Third Party Administrator in Health Insurance

third party administrator

Third Party Administrators or TPAs strengthen the infrastructure of the health insurance industry, which has to meet the needs of millions of policyholders. Today many people are opting for a health insurance cover, as medical care costs are rising. Due to this, the number of claims being filed has also gone up. To deal with this high volume of claims, insurers turn to TPAs for assistance.

What is a Third Party Administrator?

A Third Party Administrator is a company that deals with claims filed by policyholders. When people are in the midst of medical emergencies and making claims, these agencies process them on behalf of the insurers.

What services do TPAs offer?

Other than acting as an intermediary between insurers and the insured to settle claims, some other services that a Third Party Administrator render are:

  • Cashless transactions
  • Offering the insured a list of network hospitals
  • Claims tracking
  • Value-added services like consulting specialists, access to medicines, making hospital beds available, ambulance services etc.
  • Organizing wellness programmes and therapies to help you recuperate
  • Disbursement of the sum insured and collecting premiums
  • Helplines that work 24*7 to address your queries regarding health insurance


Why do Insurers and Policyholders Need Third Party Administrators?

TPAs benefit both the policyholder as well as the insurance providers in the following ways:

  • They process claims quickly which is crucial because during a medical scare every minute counts. Moreover, they take care of all bill payments.
  • TPAs are meticulous investigators. Moreover, as per the IRDAI mandate, they have their own team of medical and legal experts who can sniff out a fraudulent medical claim.
  • They minimize paperwork and unnecessary expenses.


Which Third Party Administrators Are The Best India?

Although there are plenty of TPAs present in the health insurance sector, Medi Assist is India’s largest TPA, committed to delivering informed healthcare decisions to a billion lives, connected by cutting-edge technology, partnerships and human touch. Through our strong portfolio of group companies,  we make a rich continuum of healthcare services available on our award-winning platform, MediBuddy.

Along with offering health benefits administration services such as cashless claims management, reimbursements, pharmacy benefits, and planned hospitalization, we also enable cashless outpatient services.

TPAs are irreplaceable when it comes to forming a bridge between the two parties- the insurer and the insured. So, their services are invaluable to both.

Outpatient services on MediBuddy are rendered by a wide network of
hospitals, medical and diagnostic centres that you trust. The country-
wide spread of this network allows you the assurance of quality health-
care, wherever you are.






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