What is a TPA?

A third-party administrator (TPA) is the paper-processing organization that is the intermediary between a self-insured company's employees and their physicians. It processes claims and paperwork, and sends payment to providers. Think of it as the "paperwork middleman."

The TPA is not an insurance company. It takes no risk. It simply administers the benefit plan that the company has established, and receives a fee for those services.

How Does a TPA Interact With a Provider?

The TPA handles claims processing and payment. It processes claims and sends reimbursement according to the benefit plan of each individual client company. It interacts with a provider just like any other payor.

Who Does All the Work?

We have brought together the best systems and partners for each step of the process, and integrated them into a system. Your IPA will not have any responsibilities for the daily activities of the TPA. Your role will be to provide financial and supervisory oversight.

Our systems handle all of the work, including:
  • claims administration
  • claims processing
  • reporting
  • billing coordination
  • collection and accounting for insurance premiums
  • payment of claims
  • explanation of benefits (EOB)
  • COBRA coordination
  • State and national networks for anytime/anywhere coverage

Does the market for a TPA vary by state?

State laws vary, so you'll want to consult with your own professional advisors to determine whether a TPA is a practical offering in your particular marketplace.

Does the TPA change the way I practice medicine?

No. The TPA does not dictate how you practice medicine or treat your patients. The TPA is a separate legal entity from your practice and your IPA.