Background: Cashless medical claim denials by Third-Party Administrators (TPAs) can lead   to financial burdens and dissatisfaction among patients. Objective: To analyze TPA rejections at a tertiary care hospital, identify factors contributing  to cashless denials, and suggest measures to enhance claim approval efficiency and patient  satisfaction. Methods: The data for this study was collected through a retrospective approach from a  period of March 2023 to December 2023. The dataset included information related to Mediclaim claim rejections, patient details, comments from TPAs, discharge notes, and hospital remarks. Results: The study revealed a 25% cashless denial rate, primarily due to inadequate  documentation,40% followed by TPA response time delays and claim type discrepancies and (35%). Disease categories with highest denial rates were identified.   Conclusion: The pivotal role played by Third-Party Administrators (TPAs) in facilitating the  smooth disbursement of mediclaims and contributing significantly to the hospital's revenue  stream was evident. However, the study revealed that despite the critical role of TPAs, a   considerable number of mediclaim rejections were occurring, leading to conflicts between the  hospital, patients, and their families.