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Wednesday, Aug 10, 2005

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TPAs form body

Radhika Menon

Mumbai , Aug. 9

THIRD party administrators (TPAs) of health insurance schemes in the country have come together to resolve common issues and better their image as a strong link in the healthcare business.

The Association of Third Party Administrators (ATPA) will act as a common forum to redress their grievances. Eighteen of the existing 25 TPAs have already signed up as members, according to Mr Nayan Shah, Managing Director, Paramount Health Services, the nodal TPA in the western region.

TPAs were introduced through the notification on TPA - Health Services Regulations, 2001, by the Insurance Regulatory Development Authority (IRDA). TPAs intermediate between insurance companies and the insured to facilitate the cashless service of health insurance in hospitals.

Mr Shah said TPAs often become whipping boys for the insurance company and the healthcare providers. "TPAs have been frequently blamed for their poor service and management of claims. Administering wrong ID cards to the insured has been another charge that has been laid against them. An association will provide us with a platform to air our grievances," said Mr Shah, President of the Association.

TPAs are faced with several problems. "There are several issues that can be negotiated with both insurance companies as well as healthcare providers if we get together. It has taken a while for everyone concerned to accept TPAs," said Mr Pawan Bhalla, Chief Executive Officer, Raksha TPA.

High on the ATPA agenda is the standardisation of hospital charges under health insurance, implementation of `The International Statistical Classification of Diseases and Related Health Problems (ICD-10) and grading of hospitals.

ICD-10, which has yet to be implemented in the India, is a classification used to record diseases and health problems. The World Health Organisation produces the latest version of the classification and the IRDA plans to introduce intensive training sessions with insurance companies and TPAs for the implementation of ICD-10.

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