What is a TPA in health insurance, and how hospitals should work with one

TPA stands for third party administrator. A TPA is a company licensed by IRDAI to process health insurance claims on behalf of insurers. For a hospital, the TPA is often the team that reads your pre-auth, asks your queries and approves your final bill.

What a TPA does

• Issues health cards and checks that a patient's policy is active.
• Reviews pre-authorisation requests and approves an amount, or asks for more information.
• Reviews enhancement requests during the stay and the final bill at discharge.
• Checks the final file before the insurer pays the claim.

Why the same hospital gets different questions

Each insurer sets its own rules, and each TPA has its own forms, portals and document lists. One payer may want an indoor case paper for every day, another only the discharge summary. Keeping a per-payer checklist saves a lot of back and forth.

How to make approval easy

• Use the payer's own form when it has one, and fill every field.
• Write the clinical reason for admission clearly. A tired reviewer should understand it in one read.
• Attach the reports that support the diagnosis, not just the ones you have.
• Answer queries the same day, with the exact document asked for.

Keep a payer directory

List every TPA and insurer you work with: portal links, email addresses for pre-auth and queries, courier addresses and the contact person. When staff change, the knowledge stays with the hospital.