BANKING GENERAL KNOWLEDGE
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Question
[CLICK ON ANY CHOICE TO KNOW THE RIGHT ANSWER]
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Approves the list of hospitals whose bills are acceptable
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Scrutinizes the bills submitted by the policyholder for reimbursement
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Does audit work for the insurance companies
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Arranges for the issue of policies after verification of application form
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Detailed explanation-1: -The TPA will thoroughly verify the bills and other documents after which the claim settlement process will be initiated. In the case of cashless claims, the bills will directly be settled at the hospital, whereas in the case of reimbursement claims, they will be paid to the hospital via an insurance company.
Detailed explanation-2: -1) TPAs function as intermediaries between the insurance provider and the policyholder and its key function is processing of claims and settlement. 2) The TPA issues ID cards to policyholders, which have to be shown to the hospital authorities before availing any cashless hospitalisation services.
Detailed explanation-3: -Instead of providing insurance, a TPA provides administrative services for claims to support a self-funded health plan. TPAs may also help coordinate reporting from outside vendors. Unlike an insurer, a third-party administrator doesn’t take on any risk for claims and doesn’t provide insurance or health benefits.
Detailed explanation-4: -What is the role of a third-party administrator? Third-party administrators help in maintaining the database of the policyholders. Besides this, they also help the policyholders in issuing an identity card with a unique identification number. They are responsible to expedite the claim process.
Detailed explanation-5: -TPA stands for Third Party Administrator. It is an intermediary company between an insured and insurer. It provides a supporting role to the insurer in terms of claim settlement. This body obtains a license from IRDA in order to function in the insurance industry.