The General Insurance Public Sector Association (GIPSA) has framed a set of rules to streamline the operations of the Third Party Administrators (TPA) operating in the country. The rules are expected to be notified next week. IRDA had issued 22 TPA licences so far as part of the reforms in the medical insurance sector.

GIPSA is an association of four non-life Indian public sector companies namely New India Assurance Co. Ltd, United India Insurance Co. Ltd., Oriental Insurance Co. Ltd. and National Insurance Co. Ltd.

As a first step towards streamlining the operations, all TPAs will be asked to re register with the respective insurance companies. TPAs will have to adopt the set of rules while registering with the insurance company.

As per the rules, TPAs should have a standard grading system, patient safety measures, a standard billing format, a standard documentation and standardization of charges. The rules also require a standard MoU between the provider and giver besides a premium that would remain fixed for all healthcare providers.

These features have been recommended as per the WHO's ICD 10 coding. GIPSA has short listed four TPA's to represent four regional zones around the country. The northern stretch would be handled by Med Save Healthcare based in Delhi; the eastern zone would be handled by Medicare TPA Services (I) Pvt Ltd based in Kolkata, the western zone to be handled by Paramount Health Services Pvt Ltd based in Mumbai and the southern zone would come under the purview of TTK Healthcare Services Pvt Ltd based in Bangalore.

While the authorities are yet to finalise on the standard premium rates, those seeking to re-register will have to fill the relevant documents and fulfill the required criteria as laid down by IRDA.

This move by GIPSA, if materialized, would bring in cheer and accolades among a number of medical practitioners who for the past several months were on the lookout for an alternative. “A long-awaited gesture that had to be taken by the authorities but nevertheless, with the ultimate criterion of patient-satisfaction being met, it definitely would be welcomed with open arms by many from the profession”, gushes Dr Parvez Sheikh, secretary, Bombay Nursing Homes Association and surgeon at Charak Clinic Nursing Home.

Expressing similar content is Dr Sudha Sheth, president-elect, Association of Medical Consultants and president of Bombay Nursing Homes Association. “We would often be frequented with complaints of claims not being released, or the registration being delayed due to some technical or administrative snag, or inefficient service delivery on behalf of the TPA. Hopefully, with the new directive most of the hassles could now be sorted out making life for the professionals and patients easy.”

But with speedy registration and hassle-free documentation, the new directive would also mean extra work for most of the medical professionals. “The new rules would mean increased paperwork and workload for the professionals as now records would have to be maintained, documentation be listed and grading procedures be systematized”, says Dr. Sheikh.

Also at times, government and insurance agencies themselves are not well verse with most of the rules and regulations adding to consumer woes. But, according to Dr Sheikh, all these would be gradually sorted out and it would take some time for the process to be a proper success, probably two years to be precise.