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Manish Basu

Kolkata, Nov. 10 The Insurance Regulatory and Development Authority (IRDA) will soon set up a committee to review regulations on Third Party Administrator (TPA) companies.

The regulator has started conducting inspections and ranking of TPAs on the basis of the overall performance and volume of business, according to IRDA sources.

TPAs are organisations that provide administrative services including cashless claims processing and underwriting to insurance companies.

“IRDA will soon form a committee to review the performance of TPAs on the basis of the time taken for issuance of ID cards, settlement of claims and services in 24-hour call centres,” a senior IRDA official told Business Line.

The initiative has been taken in view of repeated complaints from policyholders about the unsatisfactory service of some TPAs, the official said.

The regulator has completed the inspection of over 10 of the 28 licensed TPAs in the country based on which necessary changes in the IRDA (Third Party Administrator-Health Services) Regulations, 2001, will be made.

The training requirement, for example, was likely to be made more stringent, the official said.

TPAs, being linked to the healthcare sector, should not be allowed holidays, he added.

A medical consultant said, “TPAs and hospitals should have trained personnel so that the involvement of patients in the claims settlement process is reduced to signing documents.”

Mr Manik Nangia, Head of Products at Max New York Life said, “TPAs are essential as they serve at a sensitive delivery point.” Max New York conducts periodic joint audits of its TPA ally to ensure service quality, he added.

“The purpose of a TPA is not ideally served by some players who resort to down-pricing in order to have a competitive edge.

A more stringent monitoring by IRDA is definitely welcome,” said Ms Shobhna Kamineni, Director, Family Health Plan, the TPA for the Apollo Hospital chain.

Ms Shamita Paul, Zonal Manager, Medi Assist India, said, “TPAs suffer from a lack of basic recognition and low service charges. A common platform is a must for the interaction of all stakeholders in the claims settlement process.”

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