skip to Main Content

The Role Of A Third Party Administrator in Healthcare

When it comes to healthcare, individuals seek quality and affordability for both themselves and their families. Third-party administrator healthcare services essentially help Americans through health insurance processes, particularly with private and self-funded insurance plans. Private health insurance coverage, covering 67.3% of the American population, surpassed public coverage by 32.9% in 2018. With this increase in companies utilizing self-insured plans, it is essential to understand the roles third-party administrators have in private healthcare provider services, particularly when it comes to something like care network repricing insurance. Importantly, hiring a TPA provides flexibility to a company because they can choose how to utilize their health claims administrator.

Designing Health Plans

Third-party administrators, otherwise known as TPAs, help employees obtain health insurance plans that are customized to the company and its population’s needs. For some companies, this could mean bundling different categories of benefits, such as medical and dental benefits. Other companies may have several employees with similar health conditions, so coverage in that particular area would be important to obtain. A third-party administrator will aim to lower fixed costs, tackle health insurance claims repricing, and will be sure health plans comply with state and federal regulations.

Launching Health Plans

When launching health plans, communication between the third-party administrator, a company, and a company’s employees is crucial. TPAs must educate a company on its health insurance packages, assist in employee enrollment, and provide customer service when necessary. In larger companies, TPAs have a greater responsibility in making sure all client services are taken care of.

Managing Health Plans

Third-party administrators play an important role in managing health plans once they are purchased by a company. They assist in both consolidating and ensuring accuracy in billing, with care network repricing insurance, and with health insurance claims. TPAs see how employees utilize health plans and can offer advice on how to improve health insurance plans and coverage. This allows companies to focus on their work while receiving help in meeting all of the health needs of their employees.

In the United States, health insurance is important to both have and understand. Employees who work for companies that have hired a third-party administrator can utilize their customer service and expert knowledge to ask questions as well as seek advice on their health insurance plan, benefits, and coverage.

×Close search
Search