IRDA asks insurers for guidelines to TPAs for health insurance claims

Insurance watchdog, Insurance Regulatory and Development Authority (IRDA) has asked all general insurance companies and stand alone health insurers to provide detailed guidelines to third party administrators (TPAs) for health insurance claim settlements.

Although, TPAs are not permitted for claim settlements or rejections in health insurance policies, they may handle claims, admissions and recommend to the insurer for the payment of claim settlement on the condition detailed guideline is prescribed by the insurer to them for claim settlement.
IRDA circular said, “Every insurer utilising TPAs is advised to send a specific confirmation to this effect to the Authority on or before September 30, 2013.”

The regulator has suggested all the insurance companies to check that detailed guidelines are prepared and given to the respective TPA as per its regulation.

A TPA is an organization that processes insurance claims and also handles many aspects of other employee benefit plans such as processing of retirement plans and flexible spending accounts. This can be viewed as outsourcing the administration of the claims processing.

Source:  http://www.insuringindia.com