Maximizing Your TPA Relationship to Build Claims Results

TPAs can facilitate essential functions such as managing loss reserves, facilitating claims investigations, issuing claims payments and settlements, coordinating medical management and organizing transitional work. But getting the most out of these functions requires successful communication and planning between an employer and their TPA.

“A strong relationship with your TPA will encourage communication and exchanging ideas or suggestions, which could lead to a better understanding of work processes and goals,” said John Hinspeter, Managing Director – Claims at Safety National. “This can also build a shared desire for success and a strong commitment to the best possible outcomes. Lacking a solid relationship can lead to missed opportunities and increase the possibility of a misunderstanding or miscommunication of the desired results.”

Creating the most effective partnership between an employer and a TPA requires the following efforts.

1. Leadership

Set a vision for your goals and how you want the partnership to look. Creating an atmosphere where both the employer and TPA are empowered, influential, focused and heavily involved in all aspects of the program on a daily basis can help reach those goals. A successful partnership also relies on accountability and buy-in from both organizations’ senior leadership.

2. Framework

Initial account meetings should involve mapping out a plan and creating realistic expectations for items such as email or phone response times and appointment scheduling. Ensure you have established communication strategies and goals, sharing organizational charts with contact information for the entire team.

TPAs can better understand your business needs by attending on-site meetings and learning your business plans. However, you should thoroughly understand your TPA’s processes and why they may do things differently in particular circumstances without micromanaging. Set standards and discuss how to achieve results, but be open-minded and willing to set up different systems for items like loss reporting procedures and early intervention.

Yearly planning is key to maintaining this framework. Conduct yearly kick-off meetings to set goals, conduct checkpoint meetings throughout the year and hold stewardship meetings to help measure results and make improvements.

3. Empowerment & Unity

To create an empowered, unified team, start with establishing personal, professional and organizational values. Then, collaborate to develop goals and strategies that support those values to instill a sense of accountability in the team.

Remember that power and reciprocal trust lead to proactive behaviors that improve daily work practices leading to organizational efficiencies. Empowerment comes from explaining the “why.” Show the team what balancing the spending with the business goals means to your business to help them understand how they can manage claims proactively to achieve those goals.

4. Communication

Connecting with the TPA account manager fosters an open dialogue to share ideas and aspirations. They should actively be involved in weekly calls with the team to develop focus and allow for an opportunity to review claims status and take action.

Communicating claims data is critical to measuring overall results. Your TPA should send monthly data updates in coordination with senior management meetings to identify and discuss trends from their findings.