Professional Documents
Culture Documents
Introduction
TPA means any company who has obtained license from IRDA to Practice as Third party administrator and is appointed by the company. In lay mans term TPA is like a BPO; a common link between Insurance Company and the Customer. Insurance companies find the processing of claims to be a repetitive and standardized activity and use TPAs to outsource some of their administrative burden for a cost.
PARITY BEWEEN ROLE DEFINED BY IRDA AND ROLE IN PRACTICE PLAYED BY TPAs
Providers of services as and when needed Streamline and simplifies the claim process Automatic development of information system Ensured services of qualified registered medical professional Value added services No extra burden on insured
DEVIATION BETWEEN ROLE DEFINED BY IRDA AND ROLE IN PRACTICE PLAYED BY TPAs
Failure to meet the service responsibility Lack of knowledge about coverage and exclusion in policies Failure to meet the expectations of parties involved Delay in settlement of claims Indirect cost to consumer Cost of healthcare increases Cost of management increases