IRDA asks Insurers for Guidelines to TPAs for Health Claims
NEW DELHI: IRDA has directed all general insurance providers to provide full information to third-party administrators about the payment of claim settlements related to health care.
TPAs can handle claims, admissions and recommend the insurer for the payment settlement, as per the standards set by IRDA.
TPAs have no jurisdiction with regard to the General Health Insurance Scheme regarding claim settlements and rejections.
Each insurer must submit a policy-based confirmation to the authority on or before September 30, 2013. As per the Insurance Regulatory and Development Authority (IRDA) guidelines, insurers should also ensure that the respective TPA is issued with specific guidance in compliance with its regulations.
In the basis of a premium or remuneration, the insurance provider assigns a TPA and delivers health care on the basis of that.
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