Analysis of Turn Around Time of Claim Settlement Process in Select TPA

The turnaround time (TAT) in the claim settlement process plays a crucial role in determining the efficiency and effectiveness of Third Party Administrators (TPAs) in healthcare and insurance sectors. This study focuses on the factors impacting TAT in the claim settlement process within TPAs, identifying key challenges, bottlenecks, and potential improvements. The data is collected by administering a questionnaire with a sample size of 150 to the selected TPA staff who are working in pre auth department, CRM, billing department and medical scrutiny department and also through direct observations of claims. The Average TAT for the claim settlement process was calculated for 60 cashless, 60 reimbursement, 20 additional payments, and 10 deduction payments claims. The major findings of the study are, the average TAT for cashless, reimbursement, addition payments, and deduction payments claim settlement is 85.05, 66.2, 47.55, 23.7 days respectively. The study also found the reasons for the delay in the claim settlement process and increase of TAT in claim settlement process. Delay in document recovery, delay in processing and dispatching cheques are found as the major reasons. By examining both internal (process management, documentation, claim verification) and external (policyholder behavior, regulatory requirements) factors, the study highlights the importance of optimizing TAT to enhance customer satisfaction and operational efficiency. Some of the suggestions of the study are to increase staff, decrease time for transferring claims and at issue of cheques and has to speed up the claim settlement process.