Like HR Systems, Benefit Administration Software Is Plentiful
Numerous software systems are available for employers and employees for day-to-day HR functions. These software systems allow companies and their employees to track time, manage payroll and tax information, enroll in benefit programs, analyze performance, and more.
Similarly, a variety of benefit administration software is available for TPAs and brokers, allowing everything from COBRA and FMLA administration to life insurance and retirement plan management. The options are nearly endless.
Having options can be a good thing, particularly as it forces software companies to constantly improve their offerings — making them faster, more efficient, and more comprehensive. At the same time, it creates uncertainty for TPAs beginning new employer relationships due to potential integration challenges.
Both software categories are broad, with systems available in the hundreds. While employers have their work cut out in finding the right software for their needs, TPAs also have an uphill slope in finding the most flexible and adaptable benefit administration software.
No Risk Doesn’t Mean No Responsibility
Employees and their dependents are relying on you — perhaps without knowing it — to follow through and process their claims. Accomplishing this not only requires a streamlined process to manage that workload, but also a platform that can make sense of employee data received from different HR software platforms.
Because of the number of HR software platforms out there, not all the data that you receive will be the same. Information will be exported differently in a variety of formats. Your system may have difficulty capturing it and standardizing it for substantiation and reimbursement.
TPAs Must Bridge the Gap Between Systems
A TPA best practice is finding ways to solve problems for your clients beyond your core service offering. It’s going above and beyond. Adding value. Core elements of any customer service or experience strategy designed to maintain and improve the TPA–partner relationship.
You can add this value by addressing the challenge of managing employee claims and enrollment data quickly and easily regardless of format. You can also do it without custom software development. Tools are available now that integrate with existing common benefit administration software such as Alegeus, DataPath, and WEX Health — even homegrown platforms.
Where other TPAs weren’t able to help, you can. Where other TPAs weren’t able to manage the influx of claims and enrollment data, you can. That added value of solving for your clients through technology just became a competitive marketplace advantage that can help you grow.
Bridging the Gap with Technology
Through years of helping TPAs make benefits easier to administrate, we identified three core areas that needed better data connections and flow of information. And then created technology solutions for each.
How do you automate claims substantiation and reimbursement?
EOBs and formatting varies widely and this has required significant manual work to match the claims to the ben admin system.
TPA Stream’s Claims Harvesting software starts with a simple employee enrollment process. Then, TPA Stream harvests claims including claim details, screenshots, PDFs, EOBs in any format from over 200 carriers. Finally, the claims datail is sent to the benefit administration system to automate substantiation and reimbursement. Claims Harvesting automates enrollment, too.