Third Party Administrator (TPA)

TPA: Guiding Stakeholders in Streamlined Benefits Administration Solutions

As a Third-Party Administrator, managing benefits and related processes for self-funded employer groups can be a daunting task. However, when a TPA employer and their healthcare stakeholders are mutually aligned, an ability to reduce benefit costs while managing risk associated with high cost claims can be realized. 

Because TPAs can manage customized plan designs, employers receive what they expect in outsourced management solutions helping to control or decrease benefit utilization. Providing a collaborative approach in managing current risk, mitigating potential risk, and focusing future cost management efforts in a targeted meaningful way leads to successful outcomes desired by all related constituents in self-funded businesses.

Multiemployer configurable environments

Utilization management - referral/authorization processes

Automated claim adjudication and workflow routing

Integrated evidence-based care guidelines

Stop loss configuration and tracking

Audit and reporting management

Configurable provider and member portal setup

HIPAA-based EDI functionality to facilitate data movement

Executive and department level dashboard and actionable oversight

Flexible platform in managing risk and delegated responsibilities