A Third-party administrator (TPA) provides administrative services for
self-funded health plans, sometimes referred to as self-insured
health plans, in the health insurance industry. A TPA can also provide
access to healthcare networks and may be able to source additional
vendors, such as stop-loss insurers.
SERVICES
- Health benefits reporting and analytics: A TPA that reports on your
health program’s networks and point solutions should provide regular
and reliable reporting on claims, members, and other metrics
associated with your self-funded plan.
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Reducing the burden on your HR department: Your TPA can help
with open enrollment for your plan. Your TPA may also be able to
assist with communication materials or onboarding events.
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Adjudicating claims: A TPA can adjudicate whether claims are
reimbursable under the plan and take care of processing member
claims for your business.
- Healthcare provider network access: A TPA can help you connect
your self-funded plan to trusted healthcare provider networks.
You don’t need to assemble all the parts of your plan yourself.
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Detailed healthcare expense reporting: Gain access to more
detailed healthcare expense data without compromising
employee privacy. A TPA can provide you with reports to better
understand healthcare costs. Use the data to work with your TPA
and design wellness programs or health-based incentives that
can reduce costs in the future.
