TPA

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.
• 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.
• 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.
• 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.