Strategies for Selecting the Right TPA

 

 

Finding the right third-party administrator (TPA) can be challenging, and organizations often underestimate the time and resources required to select the best candidate for their needs. However, understanding the importance of finding the right TPA and exercising due diligence can pay dividends by ensuring smooth and cost-effective plan operation and minimizing legal risks.

 

 

Unlike insurance providers that sell coverage, TPAs provide administrative and operational service to employers. Some examples of services they provide are claims processing, management and reporting. TPAs can also help organizations with plan design and implementation. TPAs charge fees for their services and may earn commissions from premiums paid to an insurer.

 

Administering benefits can be overwhelming. Many organizations rely on TPAs to, for example, meet regulatory standards more efficiently than they could on their own. By outsourcing administrative and operational services to TPAs, organizations can focus their efforts and attention elsewhere, thereby conserving time, resources, and efforts.

 

 

It’s crucial for an organization to choose the right TPA for its needs. An organization’s goals should match the TPA’s offerings; otherwise, it may pay for services it does not need. Worse, choosing the wrong TPA can lead to poor claim outcomes, legal exposures, and higher insurance costs.

 

Choosing the right TPA can provide an organization with responsive, flexible, and personalized service. It can enable an organization to operate more efficiently by minimizing claim and administrative costs. The appropriate TPA can also offer an organization considerable knowledge and experience in administering health plans. A TPA can identify potential trouble spots and reduce an organization’s legal risks.

 

 

Each organization is unique. Selecting the right TPA depends on an organization’s specific health plan and related needs. However, a potential TPA’s qualifications, quality of services, and fees should also be considered when deciding if it’s the right fit.

 

Consider the following strategies when searching for a TPA:

 

• Understand the organization’s needs and priorities. Plans have different needs depending on the type, design, asset size, and number of participants. Knowing what an organization needs and setting priorities to meet those needs can go a long way toward finding a TPA. A suitable TPA will be able to provide answers to problems and solve issues quickly.  Our service team sits together in Wayne, New Jersey, and is always eager to help.

 

• Determine whether a TPA can meet needs. TPAs offer various services, and they should be reviewed individually. By understanding a TPA’s services and how it administers them, an organization can determine whether the TPA will meet its needs. Each of gente’s services is available individually.

 

• Ensure legal compliance. The regulatory landscape is constantly changing, so organizations should consider how a TPA remains current on legal developments and how it can help with compliance. The right TPA should be able to guide an organization through its legal issues. gente provides the highest level of support in resolving difficult compliance issues, though employer’s counsel should always be involved.

 

• Compare candidates. An organization’s relationship with a TPA is based on reliability, so any potential TPA must be able to work effectively with their client. Organizations may review metrics of a TPA’s actual claim outcomes and know how fast it pays claims as well as its error rates. By comparing these metrics to other TPAs, organizations can select the right TPA for them. gente has been proudly serving employers for more than twenty years and has well-earned reputation for high-touch, responsive service.

 

• Check references. Organizations can ask a potential TPA about other clients of similar size and needs. Then, those clients can be contacted to discuss their experience working with the TPA.  gente is happy to share references with prospective clients.

 

• Know costs. Organizations should be aware of all services offered by a TPA and know the costs of each. Understanding the terms of any agreement with a TPA, especially fees and expenses, is essential when choosing a TPA.  gente’s costs are all-inclusive and fully transparent. There are no hidden fees for any of our services.

 

• Assess data security. TPAs should have safeguards in place to handle and protect clients’ data. Verifying a TPA’s security protocols and standards will help an organization determine whether the TPA is a good fit. gente keeps ahead of security threats with a number of protections to store and transmit data securely and prevent unauthorized access.

 

Reviewing all relevant factors, quality, and cost of services can help an organization choose a TPA. After making a selection, it’s important to regularly review the TPA’s performance to ensure it is meeting the organization’s needs.

 

 

There’s a lot at stake for an organization when selecting a TPA. The right TPA can improve an organization’s claim outcomes, reduce legal exposures, and lower benefits costs. Implementing these strategies can help an organization find the best candidate for them.

 

For the best in third-party administration, contact gente today at [email protected].