Paramount Health Insurance TPA: Services, Claims, Process & Insurer Network

About Paramount Health Insurance TPA

Paramount Health Services & Insurance TPA Pvt. Ltd. (PHS), established in 1996, is a leading Third Party Administrator (TPA) known for strong service, claims expertise, fraud control, and a 15,000+ hospital network. Licensed by IRDAI in 2002, it operates across 130+ locations offering claims management, call-center support, medical opinions, and wellness programs.

Ownership & Current Status

In 2024, Medi Assist acquired 100% of Paramount TPA for ₹311.8 crore, approved by IRDAI. Paramount now functions as its wholly owned subsidiary and remains a preferred partner for major insurers and government schemes. Your policy continues to stay with your insurer, with Paramount handling cashless approvals and reimbursement processing.

In this guide, we shall delve into Paramount Health Insurance TPA, exploring how it manages health insurance claims, its processes for cashless and reimbursement settlements, required documents, and the network of insurers and hospitals it partners with. 

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Cashless Claims Settlement Process at Paramount Health Insurance TPA

Paramount Health Insurance provides a smooth cashless claims process at its network hospitals which allows policyholders to get treated without paying upfront.

Here’s how it works:

• First, ensure your policy is active and the hospital is a part of the Paramount Health Insurance network.
• Intimate your claim. For planned admissions, notify Paramount Health Insurance at least 72 hours before hospitalization. For emergencies, inform within 24 hours.
• Go to the hospital’s TPA desk and present your policy details. The desk will help with your cashless application.
• Paramount Health Insurance will process your Request for Authorization Letter (RAL) after technical checks and review of your coverage.
• Both the hospital and you will receive updates via your mobile and email regarding your cashless claim status.
• If everything is in order, Paramount Health Insurance issues an Authorization Letter for payment as per your policy’s terms.
• In case extra information is needed, Paramount will quickly raise a query to the hospital. Once cleared, your claim is processed further.

Keep your mobile number and email updated for easy communication when using Paramount Health Insurance’s cashless process. Always check hospital blacklists to avoid claim denials.

Reimbursement Claims Settlement Process at Paramount Health Insurance TPA

If your hospital isn’t in the Paramount Health Insurance network or if your cashless request didn't go through, you can still settle your expenses through reimbursement.

The process is simple:

• Intimate the claim with Paramount Health Insurance TPA. For planned hospitalizations, notify them 24-48 hours before getting admitted. For emergencies, do so within 24 hours.
• Obtain and fill out the claim forms, available at Paramount’s office, insurance branch, or their website.
• Submit all required documents within 7 days from your discharge date via courier, post, or in person at the nearest Paramount branch.
• The team at Paramount Health Insurance scrutinizes your claim according to your policy’s terms. Non-medical expenses aren’t covered and will be deducted from your final claim settlement.
• If additional details are needed, Paramount Health Insurance will contact you and provide a clear timeline for document submission.
• Upon approval, the eligible amount is credited directly to your bank account using NEFT.
• If the claim is rejected, you’ll receive a letter explaining why.

Always make sure to collect the "Policy Declaration Form" from the hospital. Submit it with your claim documents, as this can help you get discounts and negotiated rates for your treatment. Remember, Paramount Health Insurance requires transparency regarding your health policy to process claims smoothly.

Documents Required for Cashless Claim Settlement

• Duly filled Part C (Request for Authorization Letter)
• Pre-hospitalization documents such as consultation notes, investigation reports, OPD records, and hospitalization details
• Patient ID proof along with KYC documents (PAN and address proof) of the employee/policy proposer (mandatory for every cashless request)
• If the estimated treatment cost is ₹1 lakh or more, the PAN card of the policyholder/employee is compulsory
• A duly filled CKYC form of the proposer/employee is required for claims of ₹1 lakh and above

Documents Needed for Paramount Health Insurance Reimbursement Claims

• Duly Filled IRDA Claim Form (Part A by insured, Part B by hospital)
• Discharge Summary / Day Care Summary
• Final Hospital Bill (with itemized breakup)
• Payment Receipts (including deposit & final payment proof)
• All Diagnostic Reports (lab tests, imaging, etc.)
• Doctor Prescriptions & Medicine Bills
• Government ID proof (Aadhaar/Passport/Voter ID/DL)
• PAN Card (mandatory for claims of ₹1 lakh and above)
• Cancelled Cheque of the policyholder (for NEFT settlement)
• Policy Copy (if individual policy)
• For accidental cases – FIR or MLC is typically required.

For the complete official document checklist, you can visit the website.

How Do I Track the Claim Status with Paramount Health TPA?

To check your claim status online, you can visit the official Paramount TPA Claim Status portal, where you’ll need to fill in the required details.

You can also track your Paramount Health Insurance claim status through WhatsApp self-service bot, the Sarthi chatbot, and the mW!se mobile app.

All claim communication is tagged with a unique CCN Number, which serves as your reference for status updates. Once your claim is registered, you’ll get updates via SMS and email at every stage.

List of Health Insurers Associated with Paramount Health TPA

Paramount partners with a wide range of leading health insurers, including Aditya Birla Health, HDFC ERGO, ICICI Lombard, Care Health, Star Health, Niva Bupa, SBI General, Tata AIG, and others. For the full list, see Paramount’s Public Disclosure.

If you hold a health policy with any of these insurers, especially a corporate or group policy, there’s a good chance Paramount is the TPA listed on your card.

Paramount Health TPA List of Network Hospitals

Paramount Health Insurance boasts a large network of hospitals across India. To check if your desired hospital is a part of the Paramount TPA network, visit their official website or contact customer care. Always verify whether a hospital is blacklisted or excluded before getting admitted as this prevents potential claim issues. 

Paramount Health TPA Customer Care

For assistance with your policy or claims, Paramount Health Insurance offers robust customer care:

• Toll-Free Number: 1800 22 6655
• General Helpline: 022-66620808
• Senior Citizen Helpline: 022-66629813

You can also connect through their mobile app, website, or WhatsApp for a quicker and easier experience. 

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Conclusion

Paramount Health Insurance TPA streamlines health claims, offering cashless settlements and reimbursement support through an extensive hospital network and dedicated customer service. However, like most TPAs, experiences may vary. Some policyholders report delays, partial approvals, or disputes, occasionally leading to consumer complaints.

At Ditto, we do not work with TPAs for retail or individual policies, preferring in-house claim settlement teams for better accountability and a smoother experience. Using TPAs is common for corporate or group policies. Remember, Paramount is a service processor and not an insurer, so they cannot override policy coverage decisions.