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TPA / Cashless Desk Operator

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TPA / Cashless Desk Operator

Completing the "TPA/Cashless Desk Operator" practical course ensures swift employment in every hospital’s insurance & billing section amid high unemployment. With rising cashless treatments and empaneled TPAs, trained operators are critically needed to process pre-authorizations, coordinate with insurance companies, handle claims, and manage discharges. This short course delivers immediate job placement and steady demand across all multi-specialty and corporate hospitals.

Total Modules: 6 (75–80% practical in every module)

Basics of Health Insurance, Communication & Patient Interaction

  • Types of policies (individual, family floater, group), sum insured, exclusions • Basic medical terms (OPD, IPD, ICU, day care)
  • Patient greeting, query handling, explaining cashless process
  • Telephone/email etiquette for beneficiaries
  • Daily role-plays: Handling "policy not active" or "non-network hospital" scenarios on mock counters

TPA Networks, Policy Verification & Document Checklist

  • Major TPAs (Medi Assist, Paramount, MDIndia, Heritage) & insurers (Star, ICICI Lombard)
  • Policy check via e-card, URN, QR code scanning
  • Document prep (ID proof, consent, pre-auth form)
  • Network vs. non-network hospitals under "Cashless Everywhere" (IRDAI 2025)
  • Hands-on: 200+ policy verifications using sample e-cards + document sorting practice

Cashless Pre-Authorization Process (Planned & Emergency)

  • Step-by-step pre-auth form filling, timelines (48 hrs emergency, 72 hrs planned)
  • Raising requests on TPA portals (Medi Assist, Star Health apps)
  • Approval/denial criteria, query resolution
  • Coordination with hospital billing/doctors
  • 100% lab: Each student processes 250+ mock pre-auths on live-like portals

Claim Settlement, Reimbursement & Software Integration

  • Discharge process, final bill scrutiny, co-pay/deductible calculation
  • Reimbursement filing for non-network cases
  • Integration with HMS (eHospital, Insta) for auto-claim generation
  • Common rejection reasons (e.g., non-covered items) & appeals
  • Daily 6–8 hours: 300+ simulated claims + bill auditing on software

Government Schemes, Grievance Handling & Compliance

  • Ayushman Bharat, CGHS, ECHS integration with cashless
  • Medico-legal aspects (MLC cases, death claims)
  • Patient complaints, escalation to IRDAI/insurer
  • Data security, TAT compliance (12 hrs query reply)
  • Practical: 150+ grievance role-plays + scheme card verifications

Live Hospital TPA Desk Internship (Full-Time Attachment) + Placement Preparation

  • This is the 6th and FINAL module – the key to 100% employability
  • 100% Practical – 5 weeks full-time at TPA/cashless desks in tied-up hospitals (e.g., Fortis, local multispecialty with 50+ daily claims)
  • Each student handles minimum 300–400 real cases: Policy verification, pre-auth requests, query resolution, discharge settlements under supervision
  • Works morning/evening shifts, manages live beneficiary flow, emergency walk-ins
  • Learns team coordination with billing/nurses, high-value claim escalations Last 7–10 days:
  • Resume building for TPA roles
  • Mock interviews (insurer panel style: claim denial scenarios, TAT handling)
Course Includes:
  • Duration: 6 Months
  • Modules: 6
  • Eligibility: 10th Pass
  • Science preferred but NOT compulsory

For Details About The Course

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