Insurers and self-insureds utilize third-party administrators (TPAs) to handle claims and provide a variety of services contributing to an organization's risk management success. Whether choosing a TPA for the first time or making a change to a current program, the selection process can be daunting in a marketplace with an abundance of TPA choices. An effective method for an organization to narrow the TPA field is to first understand their particular needs and expectations.
TPAs can perform a variety of functions, including administering claims, ensuring compliance with various regulations in their reporting functions, maintaining records, providing analytical data, and may also produce a variety of reports. Whether an organization has a specialized staff to oversee the various claim management functions will determine the types and level of tasks to be outsourced to the TPA and influence the level of collaboration expected.
The array of services offered by a TPA is further supported by their relationships with network medical providers, medical case managers, bill review services, various specialty networks, utilization review providers, and vendors who handle a variety of compliance functions. An organization must consider whether they have relationships already in place and the TPA's flexibility in accommodating their preferences.
A prospective TPA client should also consider the current and expected future geographic spread of their operations and concentration of claim volume in particular jurisdictions. This will help to determine if they need a TPA to accommodate future growth. These factors will influence a preference for a regional or decentralized structure and for dedicated versus designated adjusters. If unique business operations present the need for specialized knowledge and expertise of the claims handler, can the TPA fulfill that need and provide support and training for the claim handlers?
Subjective measures are factors not to be ignored in the evaluation process. A insured with a clearly defined corporate culture and risk management philosophy is better equipped to convey expectations in finding the best TPA match.
For more information about exploring an unbundled program, contact an Old Republic Risk Management Account Executive at (262) 797-3400 or visit us at www.orrm.com.
The Old Republic Risk Management Claim Department provides oversight of the claims handled by the Third Party Administrators (TPAs) selected by our Insureds. Claim Specialists liaise with the TPA Adjusters and Insureds to provide guidance on the management of serious claims. The Claim Department is based out of our corporate office in Brookfield, WI.