Page 268 - IC38 GENERAL INSURANCE

b) A fixed amount for each member serviced by the TPA for a defined time
period, or

c) A fixed amount for each transaction of the service provided by the TPA –
e.g. cost per member card issued, per claim etc.

Thus through services of TPA, insurers gain access to:
i. Cashless services
ii. Data compilation and analysis
iii. A 24 hour call centre and assistance for the customers
iv. Network of hospitals and other medical facilities
v. Support to major group customers
vi. Facilitation of the claims interaction with the customer
vii. Negotiation of tariffs and procedure prices with the hospitals
viii.Technology enabled services to ease customer service
ix. Verification and investigation of suspect cases
x. Analysis of claim patterns across companies and provision of crucial
information on costs, newer methods of treatment, emerging trends and
in controlling frauds
xi. Expansion of reach of services quickly

262