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What is a Clearing House? Everything you need to know!

tpa

Clearing Houses, or Third Party Administrators (TPAs), coordinate between patient, insurer and hospital to manage healthcare payments from end to end.

The Clearing House or TPA picks up claims from your hospital’s billing software, gathers and processes documentation for each patient, and passes them on to the insurance provider. They coordinate with dozens of insurance service providers, for each patient who passes through your hospital.

Collecting documentation for each patient’s claim, filing electronic and paper claims in different styles and formats, receiving, analysing and recording reports from each insurer… it’s quite complicated for hospitals to make and maintain contact with so many different service providers!

Clearing Houses simplify this process significantly, allowing healthcare providers to coordinate with a single agency rather than with multiple insurance service providers.

There are invariably multiple claims every day against medical insurance, at a much higher frequency of claim than with life insurance, for example. As a result, it is in the interest of the insurance company to appoint a Clearing House or TPA as well. TPAs, just like insurance providers, are required to register with the Insurance Regulatory and Development Authority (IRDA) in India.

Each Clearing House is associated with a large network of hospitals and is responsible to manage all aspects of claims for these healthcare providers.

This includes coordinating with you with respect to patient care and treatment, passing on bills to the insurance provider, who pays the bills.

There are two ways patients can make a health insurance claim: Cashless Treatment and Reimbursement Treatment. A huge amount of paperwork (digital and physical alike) is generated on each of these types of claims, processed every day by the Clearing Houses.

If patients are making Cashless claims, the Clearing House collects documents from your healthcare facility and passes them on to the insurance agency. The Clearing House then coordinates with the agency and gets you your payment (usually via direct deposit) from the insurance provider.

In the case of Reimbursement claims, the patient makes full payment to the hospital. The Clearing House then assists the patient in coordinating claim process, approval and payment from the insurer.

The Clearing House simplifies the process, interfacing between hospitals and insurers to provide patients with the best possible experience.

Hospital staff have way too much on their plate to spend time helping patients process insurance claims, nor do healthcare providers typically have the infrastructure to allow multiple insurers to set up shop within the hospital premises. Equally, the last thing that patients want when they enter your premises is to work on figuring out what documentation they require to file a claim.

Hospitals, patients and insurance agencies… they’re all delighted to work with Clearing Houses to streamline the insurance claim process, saving time, money and heartburn all around!

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