Health insurance claims can be a harrowing experience if you don’t get all the necessary assistance. In this respect, the Third Party Administrator or TPA makes your health insurance claims smooth and quick.
Health insurance companies tie up with many TPAs for claim processing and management. You can choose a health insurance TPA when you buy a health insurance policy or at the time of renewal. You can also change the selected TPA when renewing your health plan. But how do you know which TPA is the best?
There are various parameters on which you can judge the different TPAs and find the best. But before looking at the parameters, let’s understand what TPAs are all about.
What is a TPA?
A Third Party Administrator (TPA) is a company that facilitates health insurance claim settlements. The health insurance TPA is an intermediary between the insurance company and the policyholder in claim processing. During claims, policyholders have to contact the TPA and intimate their claims. The TPA helps guide the policyholders about the claim process and the documents involved. The claim submitted by the policyholder is checked and verified by the TPA before passing it to the insurer. The insurance company then settles or rejects the claim based on the TPA’s verification of claim documents.
Since a TPA plays an essential role during claim settlement, choosing the right company is important. If a health insurance company is tied up with multiple TPAs, you can choose the best at the time of policy purchase or renewal.
To choose the best TPA, here are some parameters that you should consider –
# List of networked hospitals
Cashless claim settlement is available only if you get admitted to a networked hospital, i.e., a hospital tied up with the insurance company. Moreover, the TPA should also tie up with the hospital to allow quick claim settlements.
So, when choosing a TPA, check for the network of hospitals that the TPA is tied-up with. The wider the network, the better.
Also, check whether the health insurance TPA is tied up with the hospital of your choice and also hospitals in your vicinity. In emergencies, having TPAs at the nearest hospitals can be a blessing as they can help in hassle-free claim intimation and processing.
# Services offered
The next thing to check is the services offered by TPAs. Modern-day TPAs have enhanced the gamut of services that they offer policyholders. From guidance about the claim process to help you with the required documents, TPAs can prove instrumental in quicker claim settlements. So, their services should be scrutinized to choose a company that offers the most comprehensive range of services.
Moreover, nowadays, health insurance TPAs offer various value-added services, so policyholders can get additional benefits from their health insurance policies. So, check for these value-added benefits too that make a difference.
# Digital efficiency
With the advancement of technology, digitization has become a buzzword. TPAs have also streamlined their services through tech-enabled processes and digitization. Companies with cutting-edge technology to automate claim processing and allow app-based support are better since they make claims easier. So, look for TPAs that employ advanced technology in their services and processes for hassle-free and quick claim settlement.
# Quick claim processing
Lastly, the claim processing turnaround time is also an important criterion when reviewing TPAs. Companies with a shorter turnaround time are better since they speed up the claim process. So, check the claim process of different TPAs and choose a company whose process is the easiest and the quickest.
Things to know about TPAs
While you can use the pointers mentioned above to find the right health insurance TPA for your health insurance policy, here are some things that you should keep in mind –
- Some health insurance companies might have only one TPA for claim settlements. In such cases, you will have to choose the right TPA. You can, instead, choose a TPA first and then choose an insurer that is tied up with your chosen TPA.
- You can choose the TPA when buying or renewing the health plan. However, the insurance company will choose one for you if you don’t.
- Many health insurance companies have in-house claim settlements. In such cases, no TPAs are employed, but the insurer handles the claim itself.
Bottom line
If your insurer has the option of multiple TPAs, use the parameters mentioned above to find the best health insurance TPA for your claims. In the case of in-house claim settlements, know the claim process and connect with the insurer during claims to get guidance. Understand the claim process so that your health insurance claims become simplified and you get the financial assistance needed in medical emergencies.
