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Choosing a TPA - Choosing a TPA - User's Blog!

Choose the Right TPA

Changing TPAs isn’t something to take lightly. Take the time to do some background work first, to ensure the TPA you choose has the reach, resources, and flexibility to get the results you’re looking for – and the service you deserve.

1 Get approval from every carrier.

The Helmsman Advantage: We help you gain approval from not only the current carrier, but every carrier in your programs history. No stone is left unturned! In fact we go even further: 

  • We confirm that inventory can be moved and ask about other restrictions that may exist. 
  • We determine who will bear the cost if there are any additional carrier fees.  

2 Determine the scope of information transfer.

The Helmsman Advantage: 

  • We make sure your transfer includes all states, records, and claims addressing each line and year. 
  • We determine what happens with closed claims that could be reopened. 

3 Beware of additional fees.

TPAs often pass carrier fees of $1,000 to $50,000 to the customer. Midterm moves can be especially pricey if not addressed in advance.

The Helmsman Advantage:

  • We document the dates that fronting terms or excess policies expire and make sure contract terms line up.
  • We always ask for the carrier’s midterm move policy.

4 Consider vendor relationships.

Find out if your TPA has exclusive relationships with law firms and medical management firms, or requires you to use specific vendors.

The Helmsman Advantage: We work with the networks, providers, and attorneys you prefer.

5 Design a detailed transition plan.

Have the transition manager and account team collaborate to cover every aspect. Make sure all stakeholders communicate about action items, challenges, and wins.

The Helmsman Advantage: We fully engage with you and manage your transition by building milestones, contingencies, and action items into your plan.  We make it easy.

6 Allow for enough lead time to do it right.

The carrier or TPA may require up to 90 days for data reconciliation, so put the RFP out with this in mind. 

The Helmsman Advantage: We keep the implementation plan front of mind to reach target dates or consider moving to open inventory after new losses.

7 Get leadership buy-in.

Collaborate with your team, carrier, and TPA to maintain progress and resolve issues quickly.

The Helmsman Advantage: Our experienced team prioritizes clear and constant communication with you and your executive team.

8 Inform state authorities.

Most states require notice of change via specific forms from the carrier or employer.

The Helmsman Advantage: We make a checklist of state notice requirements with every transition plan to help keep things moving and prevent costly penalties.

9 Know the protocol for physical files.

If there are files in storage, confirm the new TPA has a system for retrieving archived files.  

The Helmsman Advantage: We always find out how many files are in storage, their age, and if they must move. If storage can be transferred, we determine who assumes liability for file storage fees.

10 Validate the data.

Mismatched data and gaps in data can harm financial integrity, reserves, and mandated state or statistical reporting.

The Helmsman Advantage: We make sure clients sign off when data is loaded – before it moves to production or export. This ensures claim counts and financial totals match as expected and minimize surprises.