Role of a TPA in Self-Funded Health Insurance

A third-party administrator (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.

Let a TPA Do the Work for You

A TPA takes care of administrative tasks and a lot more. Get in touch to learn more about working with a third-party administrator.