The Anticipated Evolution of Third Party Administrators

Get to Know the Third Party Administrators

Before diving into the factors causing the need for third party administrators, a little summary of their services is necessary. There are multiple functions that these organizations contribute to the healthcare industry. These functions are indirect yet inherently essential to driving up the efficiency of the overall processes. They encompass various important aspects of the healthcare industry, some of which are listed below:

Health Cards Issuance to Policyholders

Health cards are essential documents that are required during hospitalization. Third party administrators are responsible for issuing authorized health cards to the insured.

Efficient Claims Processing

Third party administrators ensure efficient claims settlement by reviewing all required documents submitted by policyholders. Once approved, they will begin the process of settling the claims. The claims processing and settlement include cashless claims approval and claims disbursement.

Provision of Value-Added Services

Third party administrators handle value-added services such as arranging for ambulances, checking hospital availability, and maintaining databases. Other value-added services even include wellness programs and lifestyle monitoring of the targeted health population. These services are often complementary and supplementary to essential healthcare services.

Improved Hospital Network

Third party administrators facilitate stronger provider networks by enlisting quality hospitals and practices. The list of approved entities ensures that policyholders can benefit from cashless healthcare services.

Better Communication Strategies

Helpline numbers are extremely helpful for third party administrators and their policyholders to resolve claims-related concerns. Aside from 24-hour toll-free helplines, other third party administrators schedule alerts and messages to the insured for clinical reminders and healthcare announcements.

Key Components that Boost Third Party Administrator Growth

There have been new and unprecedented risks that fueled the rise of the third party administrator market. Current unpredictable conditions, shifting economies, and increasing globalization are just some of the factors. Here are two components that have been considered crucial in the development of third party administrators:

Global Outlook

Currently, many corporations take a more global approach on managing and processing claims. Third party administrators often look to control costs and are more willing to carry risks. As a result, claims handling is increasingly becoming outsourced more than ever. Outsourcing allows companies to focus more on saving costs without relying on geography.

Technology

The past few years have accelerated the warm adoption of technology throughout all industries, especially in claims processing. Healthcare organizations have risen to the challenge by optimizing claims management through current technology applications. Even more so, technology has proven that businesses can be managed virtually anywhere. The current conditions have transformed the way healthcare operates and have enabled many key stakeholders to take on more responsibility.

The Imminent Future for Third Party Administrators

The roles of third party administrators are increasingly becoming more complex and expansive. The most effective organizations incorporate technology to process and manage claims. By keeping processes aligned with healthcare needs through technology, they benefit from escalated claims management.

Supporting the cause of technology for better healthcare workflows, MedVision developed the QuickCap 7 (QC7). Integrated into many diverse healthcare organizations, QC7 has proven to be a valued healthcare administration solutions. QC7 consolidates complex processes into several powerful series of quick interoperability functions. With each process designed to flow seamlessly into the next, QC7 ensures that your business functions run smoothly. QC7 allows you to:

• Enjoy simplified claims management and handle complex claims processing from start to finish for improved efficiency.
• Add, manage, and validate member eligibility and review pertinent information related to the member.
• Search, view, and manage confidential electronic data interchange (EDI) files to complete private financial transactions.
• Share and collaborate securely on care-coordinated patient cases to enhance care coordination through secure communication.

Easily customizable, QC7 automates all of your essential business processes. Transform your operations into interdisciplinary workflows that are suited to your needs. At MedVision, we believe in supporting and guiding healthcare professionals and organizations to actualize the best versions of themselves.

Optimize your TPA organizations now!

References:

1. McKnight’s Long-Term Care News. “ACO REACH Combines Innovation with Access for SNFs - McKnight’s.” www.mcknights.com, March 16, 2022. https://www.mcknights.com/marketplace/marketplace-experts/aco-reach-a-step-toward-innovation-for-snfs/.

2. Research, Allied Market. “Insurance Third Party Administrator Market to Reach $514.98 Billion, Globally, By 2030 at 6.3% CAGR: Allied Market Research.” Insurance Third Party Administrator Market to Reach $514.98 Billion, Globally, By 2030 at 6.3% CAGR: Allied Market Research. www.prnewswire.com. Accessed June 9, 2022. https://www.prnewswire.com/news-releases/insurance-third-party-administrator-market-to-reach-514-98-billion-globally-by-2030-at-6-3-cagr-allied-market-research-301448965.html.

3. Allied Market Research. “U.S. Insurance Third Party Administrator Market Size|Forecast-2030.” www.alliedmarketresearch.com. Accessed June 9, 2022. https://www.alliedmarketresearch.com/us-insurance-third-party-administrator-market-A14535.

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