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Role of a TPA

What is the Role of a TPA?

A third-party administrator, or TPA, is an organization that processes health and/or other claims for an employer benefit plan. When an employer group chooses to self-fund, they contract with a TPA to provide service for the benefit plan.

All TPAs provide a base level of service—services such as claims adjudication, customer service, eligibility maintenance, and ID card production. A TPA like HNAS can provide you with many more services to enrich your plan. We can additionally:

  • Lower fixed costs. Prepare insightful reports to help manage the plan using a holistic approach.
  • Develop wellness programs and tools to improve participant health.
  • Integrate benefits with utilization management and disease management programs.
  • Provide a premier network partner and/or pharmacy benefit manager for contracted.
  • Manage onboarding using a methodical, task-driven implementation plan
  • Oversee file feeds and/or consolidate billing among the employer’s other partner organizations and/or carriers.
  • Create customized communication materials and assist with employee education meetings.
  • Assist with plan design and draft summary plan descriptions to your specifications.
  • Ensure plan compliance with federally mandated regulations.
  • Place stop loss coverage if needed, or facilitate stop loss claims submissions with your chosen carrier.

See Why HNAS for more information about our core values for brokers and employers.

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