Home Add to Favorite Contact Submit  
             15 November, 2019
 

    
Category:  Articles » Finances » Insurance

 

Choosing a Benefits TPA

Popularity:
         Views: 2162
2007-01-30 23:54:15     
Article by Clelland Green

The use of third-party administrators (TPAs) is one of the hottest trends in insurance today. According to the Society of Professional Benefits Administrators (SPBA) 66 percent of all U.S. workers are covered under self-funded plans, most of which are managed by independent, third party administrators. But what do you look for in a TPA? If you’re an independent agent, here are some things to consider.

Where to start

Your best sources for TPAs are the SPBA and the Self-Insurance Institute of America. Most high-quality TPAs belong to one of those organizations, which can act as initial filters. Also, don’t forget word of mouth. Contact other brokers for their opinion about the TPAs they’ve dealt with.

Your first step is to determine the needs of your clients. Who are your target customers? And what types of workers do they have? Determine if your customers are fully insured, minimum premium or self-funded. Then, find out what size of self-funded groups they have: small (50-200 employees), mid-sized (200 to 2,000) or large (more than 2,000). This is important because TPAs that serve only large corporations may not be inclined to give proper attention to a company group of 75 employees. Employees kept waiting for insurance cards for two months after enrolling, for example, will complain to their chief financial officer or human resources administrator. They, in turn, will be upset with you.

Next, look for a commonality among the types of customers prospective TPAs serve. Are most of their clients in the manufacturing industry? Or do they serve companies in the technology or government sectors?

Determine whether your target customers are in a single state or if they are spread out. Also, find out what capabilities are important to them. Do they need a provider with online capabilities? Do they need a TPA that can provide self-service for employees? Are they looking for one that provides real-time information on claims?

Once you have a clear understanding of your target customers and the types of employees they have, you can start looking for a TPA that will meet your needs. But not all TPAs are created equal. In fact, if your target customers have multiple needs, you may need to work with more than one TPA.

Questions to ask

Now that you have a list of prospective PTAs it’s time to ask some questions at your initial meeting.

- How many employees is the TPA currently serving?

- What types of clients does it serve?

- Does is have a profile customer? If so, does the profile match yours?

- Is the TPA’s style a good fit with your roster of clients?

- Which provider networks does the TPA work with?

- What prescription benefit manager does it work with?

- What markets does it have for employer stop-loss insurance?

- Ask for specific information on areas such as claim turnaround time, claims accuracy, inventory control and call-to-answer rate.

- How do they audit and verify the quality of their claims?

- Ask for references.

Find out if the TPA has the ability to accept electronic claims, which streamlines the claims process. Also determine if the TPA manages paper, or if it has its claims scanned and then uses electronic data interchange (EDI). In addition, ask about the TPA’s auto-adjudication capabilities. Scanning, EDI and automation will indicate capabilities that will lead to better service.

Does the TPA’s claim system have claims-editing capability, and if so, what types of edits are included? A good system will have duplicate claim checking, upcoding and unbundling. For example, the claim system should be able to tell if the claim was unbundled and whether the sex of the claimant matched the service performed.

Next, investigate the TPA’s Internet capabilities. At a minimum, these should include enrollment and claims status. If some of your customers are not tech-savvy, find out if the TPA offers interactive voice response capabilities for enrollment and claims status.

Your next step is to ask about the types of reports your TPA can provide. You’ll often find that certain reporting capabilities are provided in the base service, while others are available at an extra cost. You’ll want to find a TPA that provides reporting capabilities as a base service. Ask if there is an added cost for additional reports.

Lastly, find out if the TPA has call tracking. You’ll want requests for service to be automatically delivered through the hall-tracking system. Find out what its service unit can complete without the assistance of other departments. This will cut down on lost time for your clients.

Specialized in: Affordable Health Insurance - Low Cost Health Insurance - Cheap Health Insurance - Health Insurance - Health Insurance Quote - Health Insurance Quotes - Medical Insurance - Pennsylvania Health Insurance - Individual Health Insurance - Family Health Insurance - Pa Health Insurance
URL: http://www.benepath.com
Print article      Bookmark this page
Related Articles 
How can Insurance Help you when Disaster and Accident Happens? (Popularity: ): Why is it important to be insured? How can it help you in the future? What are the insurance policies you need? These are the questions we have ever time we are offered an insurance. There are many factors that can affect our decision when it comes to insurance. Another question that’s very important is, are these insurance policy and company legit? It is very important to do background check ...
Did you just said you do not need Quotes on Home Insurance (Popularity: ): From the yesteryears, having a home remained the top priority of whole mankind, before building one, a man keep on dreaming about how he want it to be, and once he done, his thoughts are occupied with, how to protect his nest from blood sucking bats. One can protect his dwelling from the things that are worldly, but humankind is still forlorn when the intruder is someone out of this ...
Save your money with the best home insurance quotes (Popularity: ): It may involve years of hard work and struggle to realize a dream of a perfect home. A home is more than a structure made up of brick and concrete for some people as they invest a lot of emotions in to it, therefore it needs to be protected. Therefore, seeking home insurance quotes from different insurance companies would help in deciding the most appropriate insurance scheme that fulfills all ...
What All You Should Know to Lower Your Home Insurance Quotes (Popularity: ): Those of you who have just bought a home or planning to buy one soon must be looking for home insurance quotes as well. Online presence of all major insurance providers has made the task of getting reliable quotes easy for all. Home insurance premium that an insurance provider will charge from a home owner depends upon a number of variables. Your credit score, deductibles, home security, combining your home ...
How to Find Health Insurance (Popularity: ): Do you need private health insurance? Perhaps your government or employer-sponsored plan doesn’t provide adequate coverage. Or maybe you recently retired, lost your job, became self employed or graduated from college (and left your parents’ plan). Whatever your situation, there are a number of resources you can use to locate the right type of health insurance for your budget and needs. Local Agents A key step to finding health insurance is ...


Related Business 
Benefit Services Group, Inc. (Popularity: ): Michigan based employee benefits advisor in life, health, pension 401(k), profit sharing, defined benefit retirement, voluntary benefits, administration (COBRA, HIPPA, FSA, MSA and TPA) and financial planning.
AmeriHealth Administrators (Popularity: ): A national third party administrator (TPA) providing management services, health benefits claims administration and other outsourcing services to self-insured companies nationwide.
F. A. Richard & Associates, Inc. (Popularity: ): Provides third party administration (TPA) and operational services, including risk management and health plan benefits, to P&C insurers, self-insured, and government entities.
JumpRope.com (Popularity: ): Information on the benefits of skipping, choosing your rope, plus online store with full catalogue of ropes and resources.
Cosmetic Surgery Canada (Popularity: ): Includes referrals to surgeons in each city, information about tax benefits, information on choosing a surgeon, and information for US visitors.
Total Insurance Offers (Popularity: ): Find here good news for insurance premiums and benefits of comparing insurance companies and choosing the right fitting one, learn here how worker's compensation insurance works and full answers blog.
The acting Firm (Popularity: ): At theacting-firm.com, we have all the information for you related to Acting School, Choosing Right Acting School, Best Acting Schools, Art Schools, Online Film School and Film School. At this site you can find the best acting high schools in New York, reason to choose them, benefits you might gain while taking your acting classes, benefits at Art Schools, how you will learn at online acting schools and much more.
Tournament Players Association (TPA) (Popularity: ): Provides an opportunity for the Newcastle region's bowlers to play against each other.
TPA Computer Corporation (Popularity: ): Develops customized software applications for Taft Hartley Benefit Funds.
New England Benefits (Popularity: ): We are a leading broker of Health Insurance and Employee Benefits. Our FREE service provides benefits solutions to organizations of any size through the leading insurers and financial institutions.