What Is Third Party Administration (TPA) For Health Insurance

by J B

Third-Party Administrator is a term you could hear when looking for health insurance. It’s crucial to understand the concept and its purpose before moving on to the more difficult chapters. It’s crucial to be aware of it in order to make an educated selection.

What is a TPA?

As the name implies, a third-party administrator is someone or an organization. TPA stands for Third Party Administrator. As a result, this is someone who isn’t directly involved in the contract’s administration procedure.

What does it mean to a Health Insurance?

​ In comparison to other types of insurance, such as auto or home, health insurance has a far broader scope. This is the only reason why this insurance has so many terms, making the process appear complicated at times. Third-Party Administrator is one of these terms.

In health insurance, a TPA is a third-party administrator who manages the claim settlement portion of the policyholder-insurer contract. Here are a few topics to consider to help you better grasp TPA.

  • In the event of a hospitalization claim, TPA is a liaison between the insurer and the insured.

·         The health insurance provider selects TPA.

·         TPAs make the claim settlement process easier by handling duties like document management and hospital bill payment.


·         The Insurance Regulatory and Development Authority of India issues licenses to TPAs (IRDAI).

·         For a smooth claim settlement procedure, insurers collaborate with TPAs.

·         A single TPA can work with multiple insurers.

Role of TPA in Health Insurance

TPA’s involvement in health insurance is explained in the following sections.


·         Record Keeping

The TPA is responsible for any records that are important to the policyholder. This information is kept in a separate database.

·         Continuous Support

A number of TPAs offer round-the-clock assistance. It’s vital to remember that they’re there to help the policyholder with the settlement process and are frequently available to answer questions. This assistance is available by phone and even apps.

·         Claim Settlement

A TPA’s role in the Cashless Claims settlement process is crucial. In a Cashless Claims process, cooperation between the insurer and the hospital is critical because the bill is resolved directly between the two parties. In such cases, the TPA can help with the back-end.

·         Connecting Link

The policyholder deals directly or indirectly with the TPA in the event of a hospitalization claim. TPAs provide patients with a unique identification number that aids in claim settlement.

·         Empanel Hospitals

TPAs are also involved in the empanelment of hospitals. They look to see if the hospitals match the Network Hospitals’ requirements (tie-ups for hassle-free claim settlement).


·         Extra Services

Certain TPAs may also provide additional services to policyholders such as ambulances, extra beds, medicine supplies, and so on.

Policyholder Benefits from Third-Party Administrators in Health Insurance:

The value of TPAs to insurers is self-evident: they receive aid in settling claims. However, how does a good TPA for health insurance benefit policyholders? The points that follow will inform you.

  • Supporting each other while in the hospital.
  • Giving policyholders/patients identification cards
  •  Guidance on the proper documents.
  • A quick and painless way to settle claims.
  • Customer support 7 days per week, 24 hours per day.
  • The entire claim settlement process is simplified.

If you require TPA, you can cancel it or amend it by contacting your insurance provider. You must explain why TPA is being canceled, and it will only be canceled after approval.


So, a TPA is essential for a policyholder, a hospital, and an insurance company to collaborate. Many of the services and features offered by respective TPAs strengthen their service delivery systems and make life easier for insurers, agents, policyholders, and hospitals. Check them out before hiring a TPA to handle your claims, and if you’re currently a corporate employee with a TPA, read the terms and conditions to be sure you’re getting the most out of your group medical coverage.


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