We compliment a TPA’s offering by layering in capabilities to enhance the member experience, delivering higher cost savings and more value for their employer clients.
We bring extensive expertise when working with our TPA partners so they can focus on claims processing and adjudication while we are the customer-facing entity. We assist members with steerage to quality, cost-effective providers, accessing services, and understanding their medical concerns and needs. We also act as a coordinator between the member and the TPA to assist with any issues that may arise in regards to benefits or billing questions.
We coordinate between the TPA and reinsurance carrier to assist with identifying high-dollar claimants and providing a summary of expected ongoing costs to set appropriate group rates.