TPA

What is TPA?

An independent claim administration as standard of Insurance Company, on behalf of Insurer to handle claims of customers.

Leading TPA, professional and independent insurance claims administrator for individual and group healthcare in Vietnam.

Professional and independent claims settlement, resulting in speedy claims payment, generally within 5-10 working days

Our main services:

  • Claim data administration
  • Insurance benefit consultation
  • Claim settlement

Claim data administration

  • Support diversity of structures for Individual and EB Policy
  • Updating claim history of Insured through years. Monitor by Code, Name, DOB, ID, Insurance level, Joining date…
  • Monitoring endorsements of Insured and finalize the expenses for Insurer
  • Managing claim data: monitor claim progress, claim amount, claim type, diagnosis, medical providers , etc.
  • Generating periodic or ad-hoc report to evaluate the overview of claim usage (more than available 50 samples)

Insurance benefit consultation

  • Consult customers on insurance benefits
  • Claim consultation: reimbursement/ Direct Billing process, claim settlement procedure, document guideline, etc.
  • Update on regulation of legal authorities: Ministry of Health, Ministry of Finance and others
  • Health consultation: monthly health newsletter or advice/ recommendation of Insurer

Claim settlement

  • Advanced system allows Insmart to settle claim strictly, accurately. Able to monitor and detect profiteering and fraudulences.
  • Two full operating offices in Hanoi and HCM, together with 4 medical doctors to consult and evaluate claims.
  • All information about status of claim will be sent automatically to notify claim progress (Acknowledgement, outstanding document, claim notification, payment) by system
  • Online portal iHealthNet allows user to track on the claim status, assured limit, documents.
  • 24/7 Hotline available to service clients, Helpdesk to support customer during working hours
  • Quick procedure on Direct Billing service. In cooperation with over 200 local and 100 overseas hospitals.
  • Strictly monitor on the overall insurance usage status as well as medical service expenses;

TPA role with Customers:

  • Review claim quickly, accurately, sufficient, independently
  • Create awareness of medical knowledge and regulation
  • Personal account to track online medical history, scanned medical record, direct billing panel network and Pharmacy issuing VAT invoice
  • Supporting on claim document completion
  • Claim consultation 24/7

TPA role with Insurer:

  • Independent claim settlement department as standard of Insurer
  • Professional consultation by Insmart medical doctor
  • Comprehensive reports available online to understand claims utilization, medical diagnosis, treatment type and others to assist in cost control and premium renewals
  • iHealthNet account to manage clam data of customers
  • Monitor Insured list, reduce administration works.
  • Detect profiteering and fraudulences
Tags: TPA

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Partners and our customers

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1900.636.730
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