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.