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THIRD PARTY ADMINISTRATION

Third party administrators (TPAs) are not technically managed care organizations but play an important role in health insurance markets. Neither insurance companies nor care providers, they are intermediaries who bring all components of healthcare such has physicians, hospitals, clinics, long-term facilities, and pharmacies together.

The services include cashless service at hospitals, call centre support to policyholders, medical cost management, and management of claims and reimbursements. They also provide services to the corporate sector in designing and managing health benefit packages for their employees. Given the demand and supply side complexities in health insurance and healthcare markets, TPAs provide an important link between insurance companies, healthcare providers, and policyholders. Intermediation by TPAs ensures that policyholders get hassle-free services. Salient Features of TPA are:

  1. Exception Rule-based Validating (Medical Knowledge Based).
  2. Business Rule-based Validating.
  3. Medical Investigation and Auditing.
  4. Data Entry for Non Panel Reimbursable Claims.
  5. Claims Processing.
  6. Payment Processing.
  7. Providing service to General practitioner and Specialists.
  8. Reports.
  9. Extremely user-friendly with attractive user interface and user Dashboards.
  10. Mobile SMS (for Claims, GL, alerts, notices, etc.) & Email Services.

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Praful Bhalerao, CEO,
Health Quarters "I would hereby put on record, that we are extremely satisfied with the projects delivered by Eximius "