What are self-funded employers looking for in TPAs?

By Burcu Bozkurt

More small and midsize employers are now self-funding in order to meet coverage standards while they try to control ballooning health care costs. As more employers realize the advantages of self-funding, and as more innovative market solutions make this possible, the third party administrator (TPA) space is poised to become more competitive.

Below, we highlight three services plans should offer as they enhance the value of their TPA products.

1. Superior claims management

Employers want TPA to effectively process incoming claims. In particular, they are looking at appropriate adjuster caseloads and staffing levels. On average, most employers view up to 120 open claims as reasonable.

Additionally, employers might ask whether TPA staff are “dedicated” or “designated” for that employer’s claims, to assess whether staff are only working on their accounts or are handling multiple accounts. In some cases, employers want TPAs to have expertise in their geographic area, since states have different claims handling requirements.

TPAs should be prepared to prove that their current claims infrastructure allows them to meet employer needs.

This is a preview of restricted content.

Full access to this content is reserved for Health Plan Advisory Council members. Log in now or learn more about Health Plan Advisory Council.

Next, Check Out

How to Strategize for the Plan of the Future

More