If you’re an organization or company and you have healthcare insurance for your employees, you should consider choosing a third party administrator or TPA to handle the healthcare claims for your organization. Self managing claims within the organization can be dicey and you want an administrator on your side that can do this job for you. You can choose to outsource some of your claims to TPAs or all of them. The idea is to choose a TPA that is right for your business because they will become the face of your organization when it comes to claims and how well or badly they do reflects directly on you.
You need to do your research and choose a TPA that will work for you. This means you need to use due diligence to find a TPA that will hold up to your standards. These will be people you must trust to handle your money and make decisions on your behalf. They need to be consistent in their handling of your claims and actively work to lower costs for you.
Let’s look at some things you need to pay attention to in order to find the right third party administrator for you:
· Make sure they have a strong claims system. Do they let you remotely view your claims online? Is their system paperless or do they have paper claims and files? Do they use any kind of management software than can help you save money?
· Do they have reporting capabilities that will pick up on any loss reporting? Find out what kinds of reports they can provide and in what format they are. Find out what customized reports you are able to get.
· Do they have a good claim management program? If you ignore it, you may end up with higher costs in the end. Find out how medical bills are handled at the TPA. See if they have a panel of providers they work with and find out how they select these clinics or hospital.
· See how they handle quality control issues. How often are claims reviewed for accuracy and compliance? How do they handle internal organizational audits? While you will not find a perfect TPA, you should be able to find one that oversees itself and fixes its own problems as they arise.
· Do they have anti-fraud initiatives? You need to really find out if they have a special investigations unit that seeks out and corrects fraud.
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