At Nextcare, our management solutions have been constantly evolving digitally, ensuring that our customers experience a seamless medical journey and that we maintain our position as the leading TPA in the region.
A third-party administrator is a company that provides operational services such as claims processing and policy benefits management. Insurance companies often outsource their claims processing to third parties. Thus, such companies are called third-party administrators.
Third-party administrators are commonly used by health insurance providers, who outsource many of their administrative functions. Not only claims administration but premium billing, customer enrollment, handling policies, and other day-to-day operations are handled by a TPA.
Role of a TPA
TPAs function as intermediaries between the insurance provider and the policyholder, and its key function is the processing of claims and settlement. The TPA issues ID cards or eCards to policyholders, which have to be shown to the hospital authorities before availing any cashless hospitalization services. TPA sends all the documents necessary for consideration of claims, along with bills, to the insurer.
At the time of a claim, the policyholder has to inform the TPA. He will be directed to a hospital the TPA has a tie up with.
