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Claim Administration

Medicare Insurance TPA Services (India) Pvt. Ltd focuses on managing health benefits. Our claims administration capabilities encompass insured assistance, claim pre-certification, adjudication and settlement. We are also involved in Fund Management, Audit, Information Management, Records Inventory Management & Warehousing. We administer a variety of self-insured medical benefits plans for clients nationwide. Our tailored administration services provide flexibility and control to clients. We have access to health care networks nationwide and have an in-house pre-certification program for cashless treatment in these provider networks. We also provide stop-loss administration for our clients by administrating Fraud control system and real time estimating of loss reserves.

Medical Management

Medicares` medical management team provides expertise you can count on. Our patient care managers have extensive clinical experience and are adept at managing benefit costs, while ensuring that insured receive appropriate, high-quality medical care. We tailor managed care services to fit your individual needs in a comprehensive program that includes:

  • Pre-certification of hospital admissions.
  • Continued stay and concurrent review
  • Discharge planning
  • Retrospective admission review
  • Post-payment audits
  • Other patient care management and review services
  • Case management
  • Online Real time Information to all segments including Policy Holder, Provider and Insurance Company.

Health Care Network

Medicare Insurance TPA Services (India) Pvt. Ltd is ready to meet your organization's health care needs - whether you have Insured at a single location or at multiple locations nationwide. Our approach to health care network utilizes over 4000 of the nation's hospitals, diagnostic centers and pharmacies. We work in concert with clients to find positive solutions to their health care plan objectives. Our strategy is to find a balance between Insured access and cost savings.

Network Provider


SMS Services

***To get eCard on Mobile***
SMS "MEDICARE(space)ECARD(space)MembershipNumber)" to 56677.
eg: MEDICARE ECARD 04901000750A and send it to 56677.

***Track pre-auth status through SMS***
SMS "MEDICARE(space)DPS(space)(MembershipNumber)" to 56677 to know the pre-auth status.
eg: MEDICARE DPS 04901000750A and send it to 56677.

***Send feedback on pre-auth service***
SMS "MEDICARE(space)DPF(space)(Membership Number)-(PreAuth Number)-(number 10 -100)" to 56677.
eg: MEDICARE DPF 04901000750A-162380-100 and send it to 56677.

***Track claim status through SMS***
SMS "MEDICARE(space)RCS(space)(MembershipNumber)" to 56677 to know the claim status
eg: MEDICARE RCS 04901000750A and send it to 56677.

Health Tool

BMI Tool

Body mass index (BMI) is a measure of the weight of a person scaled according to their height. It was developed in the mid 1800s and is still used today. BMI provides a simple numeric measure of a person's "fatness" or "thinness".

BMR Tool

Basal metabolic rate (BMR) is the amount of energy expended while completely at rest. The energy used in this state is enough to allow the function of the body's vital organs, etc.

Health Awarness

``You can`t buy your health, you must earn it``

Author: Joel Fuhrman


Tips of the month


About Us

Medicare Insurance TPA Services (India) Pvt. Ltd provides customized, high-quality health benefits administration programs and related outsourcing services to Insurance companies nationwide. With several years of experience, we have become one of India`s leading third party administrators, with a reputation for flexibility, innovative services, outstanding customer service, and other unique advantages. We currently administer benefits for more than 2.5 Million members nationwide. Our clients range from individuals , credit card holders and corporate organizations in a single location to national employers with multiple work sites across the country . We also currently administer the Group Health Plans for State Governments ,with large groups covering 2.5 Million members. Medicare TPA`s Management team is staffed by experienced professionals and doctors with an average of five years experience. All of our eligible managers hold post graduate degrees in various disciplines. We are present in 262+ cities in India with skilled and trained manpower headed by strong management teams. Medicare TPA provides a wide variety of TPA services to Insurance companies nationwide

Management Team

Mr Gagan Kapur, the CEO`s leadership has taken the company to a new horizon of excellence, success and stability in the present service sector industry. Under his guidance, Medicare Insurance TPA has become one of the largest TPA, managing over 3 million plus lives across India.

With Fourteen years of experience in operations (India & Abroad) Gagan Kapur has focused on private equity investing, with dual responsibilities for investing and maintaining relationships. He has started his career with Ernst & Young he was part of EY`s Private & Financial Sponsors Group in India.

He has created a mark in the path of business by setting up and managing International operations, Lead the set up of operations in East Africa.

He is also the author of ``Conducting Successful Transactions in India`` a thought leadership publication & is a member of the TIE (The Indus Entrepreneurs) India Chapter.

Sumanta Sanyal , Sr. Vice President – Business Development & Head of RSBY , since 2004 and undoubtedly played a great role in shaping his leadership abilities.

After pursuing the Management Degree from Narshee monjee Institute of Management in the year 1992 he joined a reputed MNC as a Management Trainee in Sales & Marketing in the same year, where he performed remarkably well and went to manage several other responsibilities of the Company.

In the year 2004 , Sumanta Sanyal joined Medicare TPA Services (i) Pvt. Ltd as Head of “Networking & Hospital Management”

Slowly but steadily he grabbed bigger opportunities at the enterprise and went on to manage several divisions of the company and presently responsible for Govt . Business & Business Development.

In addition, he is also looking after a Medicare Group Company called United Medical Practicioners & Establishment Services Pvt. Ltd. ( a Medico Legal Company) as Head of Opearations & Business Development.

Debjani Ray, Vice President - Operation by profession a Nutritionist but later opted for a career in Insurance Services.

A B.Sc. and B.Ed from Jadavpur University, she completed her Post Graduation in Dietetics and Applied Nutrition from All India Institute of Hygiene And Public Health in the year 1991. Interned at CMRI in the year 1991-92 and worked as a Consultant Nutritionist at Centauri Health Pvt Ltd from 1995-2004. Thereafter joined Medicare Insurance TPA Services since March 2005. Currently heading the Customer Care vertical in the organization

Dr Sarbani Bhattacharya, Chief Medical Officer by profession a Physician but later opted for a career in Health Insurance Services.

An M.B.B.S from Guwahati University in 1992.Worked as a Junior Resident Medical Officer in the Department of Gastroenterology at Peerless Hospital,Kolkata from 1995 to 1998.Started working with Dr Utpal Ray since 1998 and assisted in numerous Laparoscopic Surgeries. Thereafter joined Medicare Insurance TPA Services since 2002. Currently heading the team of Medical Officers in the organization.


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***To get eCard on Mobile***
SMS "MEDICARE(space)ECARD(space)(MembershipNumber)" to 56677.
eg: MEDICARE ECARD 04901000750A and send it to 56677.

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Medicare Kolkata
6, Bishop Lefroy Road
Paul Mansion, Ground Floor
Kolkata - 700020

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Dr Raj Kumar
32, 4th Floor Poddar Chambers
S A Brelvi Road, Opp Mumbai Samachar Building, Fort, Mumbai
Phone 022 66377744 / 66377706; Mobile: 9821413201

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