Third-party administrators (TPAs) are health insurance
companies that provide administrative services to hospitals in India. The
process of TPA empanelment is the process by which a hospital becomes a member
of a TPA's network.
In order to become a TPA, a hospital must meet certain
criteria and go through a rigorous application process. The process of TPA
empanelment is long and complex, but it is essential for hospitals in India to
become a TPA in order to be able to provide the best possible care for their
1. What is TPA empanelment?
TPA empanelment is the process of the hospital being
registered as a member of a TPA network. The TPA network is the network of
health insurance companies that are authorized by the Insurance Regulatory and
Development Authority (IRDA) to provide health insurance services in India.
In order to become a member of a TPA, a hospital must first
meet a set of criteria that requires, among other things, all medical personnel
to be qualified and experienced �medical professionals,� and all beds, wards,
and equipment to be of an acceptable quality and standard. The hospital must
also have its own legal and financial paperwork in order, and must be able to
provide proof of good financial records.
Once these criteria have been met, the hospital must then
complete and submit an application for TPA empanelment. The application will
then be reviewed and evaluated by the TPA, which will consider the information
provided by the hospital. Once approved, the hospital will become part of the
2. Why is TPA Empanelment important for Hospitals?
Having TPA empanelment gives hospitals the access to the
TPA's reimbursement system, allowing them to get reimbursed from the insurance
companies that are part of the TPA�s network. The process also encourages
hospitals to maintain standards of quality and accountability.
In addition, TPA empanelment gives the hospital access to a
network of medical providers, laboratories, and other essential medical
services and products that are available with the TPA network. This gives
hospitals the access to a wider range of resources and allows them to focus on
providing quality care to the patients.
Finally, being part of the TPA network increases the
visibility of the hospital among insurers and health care providers which leads
to increased business. This improves the financial prospects of the hospital
and allows it to be better able to support its operations and services.
3. The process of TPA empanelment
The process of TPA empanelment includes the following steps:
Requirement Submissions : The insurance company evaluates the hospital to ascertain its eligibility criteria with the help of its TPA. This includes the submission of various documents, such as the hospital�s qualifications and its equipment, services and experience.
Cost Negotiations : Once the requirements are completed, the hospital and TPA negotiate the service charges for different treatments that the hospital may have to provide.
Agreement and Approval : Once the costs have been agreed on, the hospital and TPA enter into an agreement for the services that will be provided to the insured person. The agreement is submitted to the insurer for approval.
Implementation : After the agreement has been approved, the hospital and TPA implement the agreement and begin to provide the services to the TPA-insured individuals.
The process of TPA empanelment is an important step for
hospitals to access the reimbursement system of TPA�s and increase their
visibility to healthcare providers. It is important to make sure all required
documents are in order and that the agreement is agreed upon before commencing
the TPA empanelment process.
4. What is the process of TPA approval?
Once the TPA empanelment process is completed, the hospital
needs to be approved/authorized by the TPA to avail the health insurance
services from the TPA provider. When the hospital signs a contract with a TPA
provider, they become approved with the provider.
In order to become authorized, the hospital agrees to the
terms of the TPA provider and agrees to provide services on a pre-determined
cost to the insured person.
The process of TPA approval involves the following steps:
TPA Verification : A TPA must verify the hospital�s credentials, such as its staff, facilities, qualifications, and services offered in accordance with the requirements.
Pricing Negotiations : The TPA must negotiate the cost of the services that the hospital provides.
Compliance : The TPA needs to ensure that the hospital is compliant with the various accreditation standards that the TPA has prescribed for its network of hospitals.
Quality Control : The TPA must ensure that the hospital maintains a high standard of quality care. This includes regular quality assurance check-ups and patient feedback.
Final Approval : Once all the concerns are addressed, the TPA will grant final approval to the hospital to become part of its network.
5. The benefits of TPA empanelment
Empanelment with a TPA provider offers a multitude of
benefits to the hospital. The most significant of these are as follows:
Low Cost: Hospital administrations can save on costs due to the services being provided at lower costs when compared to other healthcare service providers.
Access to New Patients: TPA empanelment gives the hospital access to a large network of insured individuals, thus increasing the hospital�s patient pool.
Improved Quality of Care: TPA providers periodically review the quality of care being provided by the hospital and provide corrective measures as needed. This ensures that the healthcare facilities maintain quality standards.
Addressing Insurance Constraints: TPA providers help the hospital to navigate through insurance constraints and agreements related to providing healthcare services.
Ultimately, TPA empanelment provides hospitals with a number
of advantages and helps the hospital reduce the costs and improve the quality
of the healthcare services provided.
TPA empanelment is a beneficial process for both hospitals
and patients alike. Hospital administration saves costs and maximises
profits due to medical services being provided at a lower cost. Healthcare
insurance companies are able to extend coverage to a wider network of people
through their TPA partners.
Patients benefit due to healthcare insurance companies being
able to provide coverage and services that they may have not been able to
receive otherwise. Additionally, empanelled hospitals can provide better
service due to the standards that TPA providers ensure are maintained.
For TPA empanelment to be successful, hospitals must be
aware of all the requirements and the process that needs to be followed. Making
sure that all the documentation is in order is critical to ensure the smooth
and efficient empanelment of the hospital.
Overall, TPA empanelment is a beneficial process, and if
followed through properly it can be extremely successful for both the hospital
and the insurance company.