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What is the Role of TPA in Health Insurance & How it Works?

Have you ever heard phrases like “Ask the TPA,” “Get consulted with the TPA,” or “TPA will handle your claim process”? 🤔

If so, you were left wondering, what exactly is a TPA? Who are they, and what role do they play in health insurance? Well, TPA full form stands for Third Party Administrator. It is a pivotal entity that simplifies your health insurance journey by acting as a bridge between you, your insurer, and your hospital.

As you have an insurance company to buy health insurance coverage, the same way, we have a TPA in insurance to fix problems related to health insurance claims. Let’s dive deeper to understand how TPAs make health insurance hassle-free and efficient.

Team Digit

What is TPA in Insurance?
Role of TPA in Health Insurance
Why Do We Need TPA in Insurance?
How Does TPA Help Policyholders?
How Does TPA Work?
Risks and Challenges of Using TPA Services
Whom to Contact for TPA-related Services?
IRDAI-Approved List of TPA
Frequently Asked Questions

What is TPA in Insurance?

A Third Party Administrator (TPA) is an individual or group that assists in handling claims made under a health insurance policy. They are independent third parties who might help the insurance company settle claims by acting on its behalf. Simply, TPAs serve as a mid-man between the policyholder and the insurance provider.

Over the years, the number of insurers, health policies sold, types of health products and buyers increased in considerable proportion. Ultimately, it got difficult to keep track of work which did not result in quality services. Hence, IRDAI came up with the Third Party Administrators. Since then, a TPA has been held responsible for the following:

High quality, consistent services.
Processing voluminous health insurance claims.

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What is the Role of TPA in Health Insurance?

Why Do We Need TPA in Insurance?

A Third Party Administrator will take care of the hospital bills and other expenses. While you are distressed by the illness of a family member or friend, you can just take care of them. The rest will be handled by the TPA.

Every insurance company appoints a TPA for your service. You do not have to pay the administrator directly. A TPA can either approve of a cashless claim settlement or reimburse it later.

For an insured, the connection will always be between them and the insurer only. To summarise, we can put it across that TPA is needed to:

Share immense knowledge of healthcare services.
Improvise the quality of services.
Manage and Investigate the claims.
Observe the Cashless and Reimbursement TAT.

How Does TPA in Health Insurance Help Policyholders?

A TPA acts as a support bridge between policyholders, insurers, and healthcare providers. But how they are beneficial for the policyholders, let’s know:

They make sure the insured person's hospital stay goes smoothly.
They make it easier to pay cashless claims quickly.
They assist in submitting the appropriate claim paperwork.
They offer round-the-clock client service to the patients.
The services they provide are free of charge.
Helps in the effective processing of several health claims.

Role of TPA in Simplifying the Claim Process

It can be difficult and time-consuming to file and get health insurance claims approved, especially for someone who is being admitted to the hospital. In this case, a Third-Party Administrator, or TPA, is essential to obtaining health insurance benefits.
Additionally, it serves as a go-between for the insurance company and the hospital. They are in charge of efficiently collecting and resolving health insurance claims.

How Does Third Party Administrator in Insurance Work?

There are two methods used to process and settle health insurance: Cashless Claims and Reimbursement Claims. In these two situations, claim settlement with a TPA in health insurance works as follows:

TPA Role in Reimbursement Claim:

Step 1: If you use hospitalization services from non-network hospitals, you will be required to pay for your treatment upfront.
Step 2: To properly substantiate the claim, you must keep all of your medical bills, receipts, prescriptions, and other pertinent records.
Step 3: After verifying all of the supplied papers, the TPA will transfer the claim to the relevant insurance company.
Step 4: If the TPA approves the claim, the insurance company will reimburse the full amount via bank.

TPA Role in Cashless Claim:

Step 1: You must be admitted to one of the insurer's network hospitals to receive a cashless treatment.
Step 2: The TPA will then get the treatment details and prices from the hospitals.
Step 3: The TPA will confirm the policyholder's eligibility and coverage of the policy presented to the patient and let them know what is covered.
Step 4: If everything goes according to plan, the TPA will provide the relevant hospital with pre-authorization so the policyholder can get hospitalization treatments without having to pay in advance.
Step 5: At last, the TPA will pay the hospital directly on the insurance company's behalf.

Risks and Challenges of Using TPA Services

Third party Administrators of individual or family health insurance plans are linked to certain risk factors. As we have seen, some specific TPA agents have become fraud sources, causing policyholders and insurance companies to suffer financial losses.

Insurance firms must implement certain procedures, such as frequent audits and risk management controls on their TPAs, to stop fraudulent acts in order to mitigate such risks.

A TPA in health insurance must also fundamentally adhere to the legal requirements, keep up-to-date, correct data and provide the best possible customer service.

Whom to Contact for TPA-related Services?

When it comes to health insurance, understanding whom to reach out to for Third Party Administrator (TPA) service-related issues is crucial. TPAs help streamline the claim process and provide assistance during emergencies. However, you must know the right point of contact for a TPA:

Most TPAs have a dedicated customer service helpdesk or helpline number for immediate assistance.
If the TPA helpdesk doesn’t resolve your issue, contact your insurance company directly.
For cashless claims during hospitalization, the hospital's TPA desk can provide on-ground support and guidance.
As a last option, if neither the TPA nor the insurer resolves your issue, you can approach the IRDAI. They oversee insurance services and handle complaints related to TPAs and insurers.

IRDAI-Approved List of Third-Party Administrators for Health Insurance

This comprehensive list of health insurance Third-party Administrators was obtained from the official website of the Insurance Regulatory and Development Authority. Please take note that this information is being provided solely for informational purposes. Verification and appropriate caution are recommended.

Name of TPA	Registration No.	Valid Upto	Name of CAO/ CEO Address	Contact Details
Medi Assist Insurance TPA Private Limited	No. 003	20.03.2026	Dr. Mukunda Madhava, Chief Administrative Officer, Tower D, 4th Floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore, 560029	Toll-free number for senior citizens: 1800 419 9493 Toll-Free No.: 1800 425 9449 Email: cao@mediassist.in Website: www.mediassist.in
MD India Health Insurance TPA Private Limited	No. 005	20.03.2026	Mr. R. Soundararajan, Chief Executive Officer, S.No. 46/1 E-space A-2 Building, 3rd Floor, Pune-Nagar Road, Vadgaonsheri, Pune - 411 014sheri, Pune – 411 014.	Senior Citizen Helpline No.: 020-25300126 Toll-Free No.: 1800 209 7777 Fax: 1860 233 4449 Email: srajan@mdindia.com Website: www.mdindiaonline.com
Paramount Health Services & Insurance TPA Private Limited	No. 006	20.03.2023	Dr. Nayan Shah, Chief Executive Officer, Plot No. A-442, Road No. 28, Ram Nagar, MIDC Industrial Area, Wagle Estate, Thane (W) – 400 604	Senior Citizen Helpline No.: 022 66629813 Toll-Free No.: 1800 22 66 55 Email: nayan.shah@paramounttpa.com Website: www.paramounttpa.com
Heritage Health Insurance TPA Private Limited	No. 008	20.03.2026	Mr. Manash Chakraborty, Chief Administrative OfficerNICCO HOUSE, 5th Floor, 2, Hare Street, Kolkata-700001	Senior Citizen Helpline No.: 033 40145100 Toll-Free No.: 1800 345 3477 Email: mchakraborty@bajoria.in Website: www.heritagehealthtpa.com
Family Health Plan Insurance TPA Limited	No. 013	20.03.2026	Ms. Medha Sabdeep Ghugre, Chief Administrative Officer, No: 8-2-269/A/2-1 to 6, 2nd Floor Srinilaya Cyber Spazio, Road No. 2, Banjara Hills, Hyderabad – 500 034.	Senior Citizen Helpline No.: 1800 102 4273 Toll Free No.: 1800 102 4033 Email: drmedha@fhpl.net Website: www.fhpl.net
Raksha Health Insurance TPA Private Limited	No. 015	31.03.2026	Ms. Palak Dhall, Chief Administrative Officer, C/o Escorts Corporate Centre, 15/5, Mathura Road, Faridabad, Haryana - 121003	Senior Citizen Helpline No.: 1800 180 1555 Toll-Free No.: 1800 180 1444, 1800 220 456, 1800 425 8910 Email: pawan@rakshatpa.com Website: www.rakshatpa.com
Vidal Health Insurance TPA Private Limited	No. 016	15.05.2026	Mr. Rajan Subramaniam, Chief Executive Officer, First Floor, Tower No. 2, SJR iPark, EPIP Zone, Whitefield, Bangalore - 560 066	Senior Citizen Helpline No.: 080 46267070 Toll Free No.: 1860 425 0251, 080 46267018 Email: rs@vidalhealthtpa.com Website: www.vidalhealthtpa.com
Volo Health Insurance TPA Pvt. Ltd ( Formerly East West Assist Insurance TPA Private Limited)	No. 018	15.05.2026	Mr. Malay Kumar Lala, Chief Administrative Officer, 38, Golf Links, New Delhi - 110003	Ph. No.: 011-47222666 FAX: 011-47222640 Email: ceo@eastwestassist.com Website: www.eastwestassist.com
Medsave Health Insurance TPA Limited	No. 019	14.05.2026	Ms. Geeta Vaid, Chief Administrative Officer, F-701A, Lado Sarai, Mehrauli, New Delhi - 110030	Senior Citizen Helpline No.: 9319810070 Toll-Free No.: 1800 111 142 Email: geeta@medsave.in Website: www.medsave.in
Genins India Insurance TPA Limited	No. 020	10.06.2026	Dr. Sumit Garg, Chief Administrative Officer D-34, Ground Floor, Sector-2 Noida - 201301 (U.P.)	Senior Citizen Helpline No.: 0120 4144100 Toll-Free No.: 1800 890 2359 Email: drsumit@geninsindia.com Website: www.geninsindia.com
Health India Insurance TPA Services Private Limited	No. 022	17.11.2026	Dr. Vinay Chimmad, Chief Administrative Officer, Neelkanth Corporate Park, Office No. 406 to 412, 4th Floor, Kirol Road/Village, Vidya Vihar Society, Vidya Vihar (West), Mumbai-400086	Senior Citizen Toll-Free No.: 1800 2269 70 Toll-Free No.: 1800 2201 02 Ph. No.: 022-40881000 Email: vinay.chimad@healthindiatpa.com Website: www.healthindiatpa.com
Good Health Insurance TPA Limited	No. 023	26.01.2024	Ms. Saigeeta Dikshit, Chief Administrative OfficerSuite 403 – 406A, 4th Floor, Ashoka My Home Chambers, Behind Ashok Bhoopal Chambers, Sardar Patel Road, Secunderabad, Telangana State – 500003	Senior Citizen Toll Free No.: 1800 102 9919Toll Free No.: 1860 425 3232Email: saigeeta@ghpltpa.com Website: www.ghpltpa.com
Park Mediclaim Insurance TPA Private Limited	No. 025	27.09.2025	Mr. Anurag Bhatnagar, Chief Executive Officer 702, Vikrant Tower, Rajindra Place, New Delhi-110008	Senior Citizen Helpline No.: 9821236752 Toll-Free No.: 1800 11 55 33 Email: anuragbhatnagar@parkmediclaim.co.in Website: www.parkmediclaim.co.in
Safeway Insurance TPA Private Limited	No. 026	19.07.2026	Mr. Mahesh SharmaChief Executive Officer815, Vishwa Sadan, District Centre, Janakpuri, New Delhi-110058	Senior Citizen Helpline No.: 011 45451300 Toll-Free No.: 1800 102 5671 Email: ceo@safewaytpa.in Website: www.safewaytpa.in
Ericson Insurance TPA Private Limited	No. 035	17.12.2024	Ms. Punam Singh, Chief Administrative Officer, 11-C, Corporate Park, ST Road, Chembur, Mumbai - 400071 (Maharashtra)	Senior Citizen Helpline No.: 022-25280208 Toll-Free No.: 1800 22 2034 Email: punam@ericsontpa.com Website: www.ericsontpa.com
Health Insurance TPA of India Limited	No. 036	05.06.2026	Mr. Mathew George, Chief Executive Officer, 2nd Floor, Majestic Omnia Building, A-110, Sector-4, Noida 201301 (Uttar Pradesh)	Toll-Free No.: 1800 180 3600, 1800 102 3600 Email: Mathew.George@hitpa.co.in Website: www.hitpa.co.in
Vision Digital Insurance TPA Private Limited	No. 037	24.06.2026	Ms. Priyanka Jain, Chief Administrative Officer Time Square Building 3rd & 4th Floor, Sushant Lok-1, Block-B, Gurugram – 122002	Toll-free no: 1800-419-9982 Ph. No.: 0124-4003171 Email: priyanka.jain@visiontpa.in Website: www.visiontpa.in
K Insurance TPA Private Limited	No. 038	19.07.2026	Ms. Bharathi G, Chief Executive Officer, No. 32, West Woods, 3rd Floor, Y Block, 5th Avenue, Anna Nagar, Chennai- 600 040, Tamil Nadu	Email: Info@linkktpa.com Ph. No.-044 35255426
AKNA Health Insurance TPA Private Limited	No. 039	8.10.2026	Sh. B S Kaintura, Chief Executive Officer, Corporate Office: W-86/C-33 Anupam Gardens, Sainik Farms, New Delhi 110068	Senior Citizen Helpline No.: 1800-309-4455, Toll Free No: 1800-569-4455, Email:ceo@aknatpa.com, Website: www.aknatpa.com

In the complex world of health insurance, a Third Party Administrator (TPA) is your trusted partner, streamlining processes and ensuring a smooth experience.

From assisting with claims and offering cashless hospitalization to providing expert guidance on selecting the right healthcare providers, TPAs play a vital role in bridging the gap between policyholders and insurers.

FAQs about TPA in Health Insurance

All

What is the full form of TPA and what does it mean?

A TPA, or Third Party Administrator, is an entity that processes insurance claims or provides administrative services on behalf of an insurance company. It acts as a bridge between policyholders, insurance companies, and hospitals.

Which is the best TPA for health insurance?

The market offers a wide range of TPA service providers. Since it depends on each individual's needs, there is no such thing as the best TPA. Therefore, before selecting a health insurance plan, one should review all of a TPA's records on the IRDAI website.

How does a TPA benefit policyholders?

TPAs streamline the claims process, provide 24/7 customer support, and ensure faster and more efficient claim settlements. The TPA acts as a barrier between the policyholder, insurance company and the hospital and fulfils the requirement of each one.

Are TPAs independent entities?

Yes, TPAs are independent entities authorized by the Insurance Regulatory and Development Authority of India (IRDAI) to act on behalf of insurance companies.

Can policyholders choose their TPA?

No, generally, you cannot choose your TPA. The insurance company assigns the TPA, but some insurers may allow policyholders to choose from a list of approved TPAs. You can discuss this with your insurance company.

What is the role of a TPA in cashless hospitalization?

TPAs facilitate cashless hospitalization by coordinating with network hospitals to settle bills directly with the insurer, reducing policyholders' out-of-pocket expenses. They also help policyholders manage their bills (in cashless claims) and assist with the paperwork.

How do TPAs handle reimbursement claims?

For reimbursement claims, TPAs collect necessary documents from policyholders, verify them, and process the claim for payment. These documents are collected after the treatment and submitted to the insurance company after full verification. The insurance company then settles the bills.

What is the difference between a TPA and an insurance company?

There is a vast difference between a TPA and an insurance company. While insurance companies underwrite and sell policies, TPAs focus on administrative tasks like claim processing and customer service.

Do all health insurance policies involve TPAs?

No, not all health insurance policies involve TPAs. Some insurers manage claims and customer service in-house. However, you can reach out to the TPA appointed by IRDAI if you need help with the claims and your insurance company needs to be more helpful.

What documents are required for claim processing by a TPA?

Required documents typically include:

Claim forms
Medical reports
Hospital bills
Discharge summary
Any other relevant medical documents.

Can TPAs reject claims?

Yes, TPAs can reject claims if they do not meet the policy terms and conditions or have insufficient documentation. They can also reject a claim if the documents submitted are not accurate or you have filed for a false treatment claim.

How do TPAs ensure the quality of network hospitals?

TPAs regularly audit and evaluate network hospitals based on service quality, infrastructure, and patient feedback. If you are undergoing a planned cashless treatment, you can connect your TPA and discuss which hospital to choose based on these factors.

What is the turnaround time for a TPA to settle a claim?

The turnaround time varies from insurer to insurer. However, it is generally done within 15-30 days from the date of claim submission. The claim is only processed if the provided documents, like medical bills, reports and claim forms, are accurate.

What should policyholders do if they are dissatisfied with their TPA?

If you are unsatisfied with TPA's service, you can escalate the issue to the insurance company. If the company is not responding to this, you can file a complaint with IRDAI.

Do TPAs charge policyholders for their services?

No, TPAs do not charge policyholders directly. The insurance company covers their fees.

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CIN: U66010PN2016PLC167410, IRDAI Reg. No. 158.

Go Digit General Insurance Limited (formerly known as Oben General Insurance Ltd.) - Registered Office Address - 1 to 6 floors, Ananta One (AR One), Pride Hotel Lane, Narveer Tanaji Wadi, City Survey No.1579, Shivaji Nagar, Pune-411005, Maharashtra | Corporate Office Address - Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru-560095, Karnataka | Trade logo of Go Digit General Insurance Ltd. displayed above belongs to Go Digit lnfoworks Services Private Limited and is provided and used by Go Digit General Insurance Ltd. under license.

What is the Role of TPA in Health Insurance & How it Works?

Table of Contents

What is TPA in Insurance?

What is the Role of TPA in Health Insurance?

Claim Settlement

Service Arrangement

Assistance & Guidance

Providing Health Cards

Documentation Process

Build a Strong Network of Hospitals

Why Do We Need TPA in Insurance?

How Does TPA in Health Insurance Help Policyholders?

Role of TPA in Simplifying the Claim Process

How Does Third Party Administrator in Insurance Work?

TPA Role in Reimbursement Claim:

TPA Role in Cashless Claim:

Risks and Challenges of Using TPA Services

Whom to Contact for TPA-related Services?

IRDAI-Approved List of Third-Party Administrators for Health Insurance

FAQs about TPA in Health Insurance

What is the full form of TPA and what does it mean?

Which is the best TPA for health insurance?

How does a TPA benefit policyholders?

Are TPAs independent entities?

Can policyholders choose their TPA?

What is the role of a TPA in cashless hospitalization?

How do TPAs handle reimbursement claims?

What is the difference between a TPA and an insurance company?

Do all health insurance policies involve TPAs?

What documents are required for claim processing by a TPA?

Can TPAs reject claims?

How do TPAs ensure the quality of network hospitals?

What is the turnaround time for a TPA to settle a claim?

What should policyholders do if they are dissatisfied with their TPA?

Do TPAs charge policyholders for their services?

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