Insurance & Mediclaim

Specialties include

What is a Third Party Administrator (TPA) & How does it work?

Third Party Administrators (TPA) is an important link between Insurance company’s policyholders & healthcare providers (Hospitals and nursing homes).TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies.

insuService offered by TPA for policyholder & Health care provides & Healthcare Provider

1. Cashless Hospitalization : Each policy holders is provided with a list of empanelled hospitals where in he/she can avail cashless hospitalization

2. ID card : TPA provides ID cards to all their policy holder in order to validate their Identity at the time of admission

3. Claims Management : On behalf of insurance companies TPA administers & settle claims for hospitals & policyholders

4. 24 hours customers support services : TPA provides assistance through its 24 hrs call center information regarding policyholder’s data, provider network, claim status, benefits available with existing card holder, etc is furnished on request.

If you have a medical insurance please check out the following details :

Have you received the insurance cards from Third Party Administrator? If not contact your agent or TPA.

If you have received the Insurance ID cards check the name of the TPA before getting hospitalized.

If you have fresh policy / first year policy or recently got your policy renewed check with your TPA about your policy enrollment, failure of which can result in rejection of your cashless authorization request.

Medical insurance do not cover your OPD consultation / procedure / investigation done before being hospitalized.

All claims of the discharge from the hospitals will be processed by the TPA directly / or for reimbursements of all your post discharge expanses directly file all originals documents, bill, prescription in TPA.

For Emergency Hospitalization

Policyholder can be hospitalized in emergency after showing their Insurance card or policy copies and are supposed to fill an undertaking form at the emergency reception. They should complete pre-authorizations formality filled by the concerned doctor.

TPA will issue an authorization letter for the coverage as per the policy to Medicare Hospital & Research Centre. The answer will come from TPA in the form of authorization letter.

Medical insurance do not cover your OPD consultation / procedure / investigation done before being hospitalized.Policy holder can directly approach the hospital Admission Counter for admission with the ID Card and one copy of the authorization letter will be given to the Admission / IP billing counter.

Hospital will extend cashless treatment to the policyholder up to the authorized amount.

In case the authorized limit get exhausted get in touch with Insurance helpdesk.At the time of discharge, policyholder has to inform the Insurance desk & is supposed to signs the claim form.

We help you with cashless mediclaim processing for the following Third Party Administrators (TPA)

  • Bajaj Allianz General Insurance.
  • Bharti AXA.
  • Chola Mandalam MS General Insurance.
  • Dedicated Health Care Service TPA Pvt. Ltd.
  • E Meditek Global pvt. Ltd.
  • Ericsson TPA Health Care Pvt. Ltd.
  • Family Health Plan TPA Ltd. (FHPL)
  • Focus Health Service TPA Pvt. Ltd.
  • Good Health plan Ltd.
  • Genins Health Management Service
  • HDFC Ergo Genereal Insurance
  • IFFCO Tokio General insurance
  • ICICI Prudential
  • L & T General Insurance Co. Ltd.
  • Medi Assist India TPA Services
  • Medsave Health Care Ltd.
  • Max Bupa Health Insurance Co. Ltd.
  • MD India Health Care Service TPA Pvt. Ltd.
  • Paramount Health Service TPA Pvt. Ltd.
  • United Health care Parekh TPA Pvt. Ltd.
  • Reliance General Insurance Co. Ltd.
  • Religare Health Insurance Co. Ltd.
  • Raksha TPA Pvt. Ltd.
  • Royal Sundaram
  • Star Health & Allied Insurance Co.
  • Universal Sompo general Insuranrance Co. Ltd.
  • Vidal Health care Services Pvt. Ltd.
  • For further assistance, please contact our TPA Assistance desk or Mr. Ashwin Boyat

    0731-4271600, 8889912610