Heritage Health Insurance TPA

Quick Overview

Heritage Health Insurance is a Third Party Administrator (TPA) company (IRDAI license No. 008). It manages claims and processing on behalf of its clients, which include health insurance companies such as New India Assurance, Oriental Insurance, and United India. Think of it as a front office for these insurers when it comes to claims.

From pre-authorization, customer assistance, policy servicing, and claim processing support, Heritage Health Insurance handles everything end-to-end.

Imagine you are hospitalized after an accident. You feel reassured because you already have health insurance. But when you try to raise a pre-authorization request, you realize the claim is being handled by a company you have never heard of. This usually happens when your insurer uses a TPA.

In this guide, we will discuss the details of Heritage Health Insurance TPA, the insurance companies associated with it, and other claims processes.

About Heritage Health Insurance TPA

Heritage Healthcare is one such TPA. Founded in 1998, it is part of the SK Bajoria Group, which has a presence across sectors such as stockbroking, manufacturing, and art promotion. Its clients include some of the biggest insurers in the market. Heritage Health Insurance TPA also has an international tie-up with World Travel Assist in the USA to support policies with overseas coverage.

How TPA-Insurer Partnerships Affect Policyholders

TPA-insurer partnerships shape how smooth or stressful your health insurance experience can be. While the insurer determines your coverage, limits, and premiums, the TPA handles on-the-ground work such as cashless approvals and claim processing. A well-connected and efficient TPA can mean faster approvals and fewer follow-ups, especially during emergencies. However, if the TPA’s hospital network is limited or their processes are slow, policyholders may face delays and frustration, even with a solid policy.

Heritage Health Insurance TPA has tie-ups with:

CTA

What is The Cashless Claims Settlement Process at Heritage Health Insurance TPA?

Step 1: Choose a hospital from Heritage TPA’s network and show your Heritage TPA ID card at the time of admission.

Step 2: The hospital sends a cashless treatment request to Heritage using the required pre-authorization form.

Step 3: Heritage reviews the request and, if approved, issues an authorization letter to the hospital confirming the payable amount.

Step 4: After your treatment and discharge, the hospital collects all original medical and billing documents. These are submitted to Heritage TPA for verification.

Step 5: Once verified, Heritage TPA instructs the insurer to pay the hospital directly.

Note: In case of an emergency, you can get admitted to a network hospital first and complete these formalities afterward.

What is The Reimbursement Claims Settlement Process at Heritage Health Insurance TPA?

Step 1: Inform Heritage TPA of the hospitalization, preferably before admission or, at most, within 24 hours of admission.

Step 2: Collect all invoices and bills from the hospital, and pay the final amount out of your own pocket.

Step 3: After discharge, fill out the reimbursement claim form and submit it to your insurer.

Step 4: Once the insurer contacts you, submit all required documents in original within the given deadline.

Documents Required for Claims Handled by Heritage Health Insurance TPA Pvt Ltd.

Filled claim form
Hospital bills, receipts, and discharge summary
Pharmacy bills with valid prescriptions
Lab reports with a doctor’s note explaining the tests
Surgeon’s certificate, surgery details, and all doctor/specialist bills
Fitness or recovery certificate from the treating doctor
Copy of Heritage TPA ID card and policy schedule

How Do I Track A Claim Status With Heritage Health Insurance TPA?

You can check your Heritage Health Insurance claims status in two simple steps:

Visit the online portal to track your claim
Enter your Claim control number (CCN), car number, or employee number

Heritage Health Insurance Network Hospitals

You can easily find the network hospital list by following these steps:

Step 1: Go to Heritage TPAs’ official website, navigate to the ‘Hospitals’ tab, and click on ‘Find Hospitals’. Alternatively, you can download the ‘Heritage Health Member App’ on Android, log in by providing your member ID, and follow the same steps.

Step 2: Provide the Hospital type, insurer name, state, and hospital name (optional) to find the desired hospital.

How Can I Contact Heritage Health Insurance TPA?

Call their all-India toll-free number: 1800-345-3477
Policyholders can use the emergency helpline:
Visiting any of their branches in person

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 8,00,000 customers with choosing the right insurance policy. Why customers like Pallavi below love us:

No-Spam & No Salesmen
Rated 4.9/5 on Google Reviews by 15,000+ happy customers
Backed by Zerodha
Dedicated Claim Support Team
100% Free Consultation

Confused about the right insurance? Speak to Ditto’s certified advisors for free, unbiased guidance. Book your call now, or chat with us!

Ditto’s Take On TPAs

At Ditto, we do not work with TPAs due to concerns about efficiency and timely claim settlements. If you still choose a policy serviced by a TPA, make sure they have a strong hospital network and a good track record of settling genuine claims without unnecessary hassle.

That said, insurers with in-house claims teams for retail plans are usually a better choice. Since they handle everything directly, approvals are faster and more reliable. If you bought a policy through us, you can contact us here.

Frequently Asked Questions

What’s the difference between a Health Insurance Company and a TPA?

A health insurance company is the provider of your health insurance, which pays in case of a claim, based on the terms of the policy. A TPA is a company contracted by your insurer that collects and processes claims on its behalf.

What are the common reasons for claim delays or rejections?

Claim rejections or delays generally occur due to non-disclosure of past medical history, a claimed condition falling within the waiting period, incomplete documentation, filing claims after the claims window closes, and the unavailability of further clarifications sought by the insurer.