Office of Compliant Administration (OCA) – Claims Harvesting

The Challenge: OCA needed a way to make claims substantiation more efficient and strengthen their competitive advantage when searching for new business.

The Solution: TPA Stream partnered with OCA to automate as much of their substantiation process as possible, making the experience better internally and externally.

The Result: Using TPA Stream, OCA has been able to grow and scale painlessly while also gaining a competitive advantage and a stronger selling point for new client business.

The Challenge

OCA, or Office of Compliant Administration, was founded in 1983 as a full-service employee benefits brokerage firm. Over the years, OCA expanded its services to provide more solutions ranging from insurance coverage to plan administration. Eventually, the company transitioned to focus exclusively on third-party administration (TPA) services.

Despite changes to its offerings over the years, one simple yet meaningful service has always remained a core focus of all that OCA does: helping people — from brokers and insurance carriers to the employers and employee members that rely on it for benefits administration.

As a TPA, most of OCA’s work involves substantiating claims for plan members. In order to reimburse members for a medical expense, an explanation of benefits (EOB) is required. This document is sent to the member by the insurance carrier and details the services provided and who is responsible for specific charges. OCA needs those EOBs to substantiate members’ claims, but because most insurance carriers don’t work with outside service providers such as TPAs, the company needed a way to more efficiently obtain EOBs from insurance carriers.

Up to this point, obtaining EOBs was a heavily manual process for both OCA and plan members. Members would have to fill out a claim form, submit it in via email or fax it to OCA, and then wait for OCA to review and approve it. There were no connections between their systems and those of OCA to make the process more efficient.

“Everything that we were touching — from claims processing to enrollment eligibility — was an incredibly manual process,” said Ross Honig, OCA’s Senior Vice President of Business Development. “We started looking for some solutions that would help make us more efficient.”

The Solution

OCA partnered with a couple of software companies serving the TPA industry. Ultimately, in both relationships, OCA determined that the software wasn’t what it needed to make claims substantiation more efficient. Coupled with a few negative experiences, OCA understandably had some hesitation when it had to start searching for a new solution for the third time. OCA discovered TPA Stream and signed up for a demo to see our platform.

“We were hesitant given our negative experiences with the other two companies, but when we saw TPA Stream, we knew it would work,” Honig said. “Since that day, they’ve continued to blow us away with what they’re able to do, their efficiency in getting things done, and their responsiveness to our needs.”

“Using TPA Stream completely automated our reimbursement process — it’s allowed us to grow our business tremendously.”

Now, by offering TPA Stream and utilizing its portal integrations, OCA can access members’ EOB information automatically once members have provided their login information for insurance carrier portals. EOBs are then submitted back into OCA’s claims system for substantiation and reimbursement. While automating EOB harvesting has helped OCA immediately improve its efficiency and overall productivity, it’s also helped with winning new client relationships.

“From a new business perspective, you have to have something like TPA Stream to be competitive in this industry. Our number-one selling point now for getting new clients into our main HRA product is TPA Stream’s ability to accurately and correctly pull member EOBs from their carrier portal. Nine out of ten clients that have an HRA with OCA also have TPA Stream. It’s a big differentiator for us and has become part of our selling story — not only are we compliant, but we’re also the easiest to work with.”

“From a new business perspective, you have to have something like TPA Stream to be competitive in this industry.”

The Result

“TPA Stream has allowed us to become more profitable. We’ve automated so much that we can now allocate time and resources elsewhere to grow more and scale up,” Honig said. “I don’t need people touching data anymore. It’s all done automatically. I can bring in more business with minimal impact on our workload yet with a significant positive impact on revenue.”

“TPA Stream has allowed us to become more profitable. We’ve automated so much that we can now allocate time and resources elsewhere to grow more and scale up.”

TPA Stream continues to support OCA in other areas beyond benefits administration as well. Recently, OCA migrated to a new benefits administration platform, which TPA Stream assisted with. As part of that migration, OCA realized that it needed a fully integrated invoicing platform. TPA Stream developed this platform for OCA to optimize the capabilities of the new system.

“What they’ve done for us has made us more efficient and automated everything that we can possibly automate. We’re also getting them more involved in other areas of our business to help make our work there more efficient as well. They’ve helped us completely change our business model as well as re-evaluate everything that we’re doing. We now ask, ‘Can this be automated? Can this be done more efficiently?’”

Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better benefits by connecting systems, transforming data, and helping TPAs unlock more revenue.

Learn more about TPA Stream here.

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