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Standardization of Tariff Format


  • Soujanya K.
  • Agency : ILBS, OPD, Radiological, Average waiting time
  • Objective : Indian Health insurance marked the beginning of new era from the year 1999. With the passing of IRDA, insurance was opened to private and foreign participation. TPA (Third Party Administrator) serves as a liaison between the insured people, company and health care providers. TPA will typically claim the file for the insured, but will also certify insurability for the insurance company. Health insurance in India is growing at the rate of 50% and TTK Healthcare TPA Private Ltd is one of the 30 TPAs in India and is ranked 1 among the TPAs. TTK has recorded the fastest settlement of claims in India. TTK has empanelled around 5800+ hospitals and is first to introduce case management in India among TPAs. The project titled “Analysis of Hospital Tariff Compliance” focuses on the tariffs of the hospital for a maternity ailment for the insurance policy holders. It also focuses on the variation in the tariffs for different type of claims and also the variation within the same type of claims. The factors considered are:
    1. Hospitals following itemized billing
    2. Type of claim- cashless claims and member reimbursement claims
    3. Ailment
    4. Geographical location- Bangalore
    5. Specific year- March 2011 to March 2012 6. Grades of the hospital- A1
    Considering all these factors data is collected from MIS for top 5 A1 hospitals in Bangalore for the year 2011 and 2012 for all the ailments. Around 6372 cases are identified from the data, after filtering and sorting the ailment recording the maximum number of cases is identified i.e. maternity and the hospital recording the maximum number is also identified in the same manner which is showing 300 cases for that year and for maternity ailment.
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Indian Health insurance marked the beginning of new era from the year 1999. With the passing of IRDA, insurance was opened to private and foreign participation