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How TPAs Work and How They Differ from Health Plan Consultants

Third Party Administrator

Back in 2018 27.5 million people lacked health insurance at some point within the year. While for many, health insurance is an expense that they simply don’t wish to pay for, other people do have questions about what a third party administrator does and how they can help streamline the health insurance process. Let’s delve into what a TPA or a third party administrator does and how they assist.

What Does a Third Party Administrator Do?

A third party administrator is a business or an entity that provides as well as delivers different administrative services on behalf of a specific insurance plan, such as a health insurance plan. Oftentimes, third party administrators are called TPAs. However, there are times that they are referred to as ASOs or administrative services only. In the case of ASOs, they may have more limitations than a typical TPA. Third party administrators make a commission once premiums are paid to an insurer for health insurance coverage. Third party administrators can also request money for specific fees, while also making money through both fees and commission, based on the scope and number of services that they offer.

Why Does an Insurance Company Use a Third Party Administrator?

An insurance company utilizes a third party administrator to help manage its provider networks, claims processing, membership functions, and more. TPAs also help to maintain
Various aspects of employee benefit plans such as flexible spending accounts and the processing of retirement plans.

How Does a TPA Differ from a Health Plan Consultant?

A third party administrator assists with the launch, design, and continuing management of the health plan. Because of these activities, they differ from a health plan consultant. While a health plan consultant may offer assistance with the design of a health plan, they don’t provide any assistance with the plan’s administration. Third party administrator healthcare entities may also help with coordination efforts for vendors needed and other services.

As your insurance provider, we can also provide third party administrator services and solutions. Located in Doral, FL, we offer provider services, client services, and more. We utilize the most ground-breaking and innovative technologies to make members aware of the primary care doctors, hospitals, ambulatory services, and more. We also help keep clients abreast of the latest information from group health providers, health insurance claims repricing, and more. Connect with us for the third party administrator services and solutions you need. We’re here to assist and help streamline the health care insurance system for you.