Section 19 in Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) Regulations, 2016
19. Maintenance of books of account, records, and confidentiality of information, submission of annual report to Authority.
(1)A TPA shall maintain proper records, documents, evidence and books of all transactions carried out by it on behalf of an insurer in terms of the agreement between the insurer and the TPA.(2)The TPA shall maintain books and accounting records in accordance with the provisions of the Companies Act 2013. All other records shall be maintained for such period as may be specified by the Authority.(3)Such records, documents, evidence, books etc., and any information contained therein shall be made available to the insurer, the Authority or to such person appointed by the Authority for investigation into or inspection of the functions of the TPA.(4)While maintaining the records in terms of regulation 19 (1) and 19 (2) of these regulations, the TPA shall follow strictly the professional confidentiality between the parties as required. However, this does not prevent the TPA from disclosing the relevant information relating to business of TPA to any Court of Law, Tribunal, the Government or the Authority in case any investigation is carried out or is proposed to be carried out against the insurer, TPA or any other person or for any other reason.(5)The TPA and insurer shall establish electronic systems for seamless flow of data for all the claims and shall follow standards and protocols for capture of data as may be specified by the Authority from time to time.(6)[ Where TPAs maintain files, data and other related information pertaining to the settlement of claims in electronic form, maintenance of the same by the TPAs again in physical form is dispensed with. TPAs shall submit or handover all the files, data and other related information pertaining to the settlement of claims to the respective insurers within 90 days after close of every quarter commencing from April of every financial year and the insurer shall accept the same under acknowledgement.] [Substituted by Notification F. No. IRDAI/Reg/15/166/2019, dated 3.12.2019 (w.e.f. 14.3.2016).](7)A TPA shall not share the data and personal information received by it for servicing of insurance policies or claims thereon except as provided under Regulation 19 (4) of these regulations.(8)A TPA shall furnish to the insurer and the Authority an annual report and any other return of its activities as may be specified by the Authority.(9)The Annual Report duly certified by one of the Directors of TPA and the Chief Administrative Officer or the Chief Executive Officer shall be submitted in such form as may be specified by the Authority, within a period of ninety days after the close of each financial year or within such extended time as the Authority may grant based on an application.(10)Every TPA shall file periodical information to the Authority relating to Claims data in such form as specified by the Authority.(11)Every TPA shall furnish declarations and undertakings in such form and at periodicity as may be specified by the Authority.
