Three EOB Processing Challenges Facing TPAs Today

EOB Processing

As a third-party administrator (TPA), you have quite a bit on your plate. You have to build and maintain relationships with brokers who rely on you to keep their clients happy and manage the details once you’re in the door. You have to work closely with employers who also expect certain service levels and results for their employees. You have to work directly with employees who are eagerly expecting reimbursement for medical claims.

This is all on top of your actual day-to-day workload: EOB processing. Needless to say, you and your team have quite the responsibility on your shoulders. But this workload is just the beginning — there’s actually far more that you have to consider and plan for in order to meet your goals. Let’s take a look at a few of the specific EOB processing-related challenges that TPAs are currently facing — and have been facing for some time.

1. Industry Inefficiency Leads to EOB Processing Inefficiency

While having a significant workload isn’t necessarily itself a problem, it’s how you’re approaching it that matters. According to The Commonwealth Fund, healthcare administration is one of the most inefficient aspects of the U.S. healthcare system. 

Our system consistently ranks as one of the most inefficient systems in the world. Whereas other systems and companies standardize their benefits packages for easier and simpler administration, our doctors, patients, and insurance companies are caught in a constant state of back-and-forth — leading to higher and higher administration costs.

As a TPA, you’re stuck right in the middle of this inefficiency, which makes your day-to-day operations and responsibilities more tedious and time-consuming. As TPA inefficiency increases, it becomes harder and harder to maintain the important relationship aspect of your business and consistently show timely EOB processing results and performance.

2. Solutions Are Available, But How Much Do They Really Solve?

There are a number of tools available in the marketplace to help TPAs with certain business functions. Everything from EOB processing and capture to various billing and accounting functions. But what are they really helping TPAs achieve in their day-to-day operations? 

While you may find an EOB automation solution that retrieves the information you need, what happens next? Sure, you’ve saved a significant amount of time in your EOB processing workload by being able to automatically retrieve the EOB, but there’s more work to do than gathering documentation alone. You have to submit this information for substantiation and reimbursement, which can be equally as time-consuming if left unautomated.

Even still, there’s more to being a TPA than EOB processing. How are you getting this information into your benefits administration system? How is the necessary information getting to the right party? Is this aspect of your work still being performed manually? Even with an automated solution for EOB processing, there’s still a fair amount of work to be done — and automation is critical for getting it done quickly. 

This is particularly important toward the end of the year when participants are under a time crunch to get certain medical expenses reimbursed. If only half the process is automated, only half the challenge has been solved, and you’ll still be feeling the pressure when year-end comes around and those claims start coming in.

3. EOB Processing is Just One Piece of a Bigger Picture

At the end of the day, you’re a business just like all those brokers and employers that have chosen to work with you. Your profitability is tied to your ability to offer efficient EOB processing and other services. That profitability extends beyond the EOBs themselves, too. 

Imagine if you weren’t able to efficiently initiate, process, and close claims submissions as you received them. Imagine if participants started following up on their claims, wanting to know what’s taking so long. Their employers and the brokers that brought you into the mix would soon hear about it. Left unresolved for too long, and you won’t be at the top of their list for future opportunities, and their relationship with your TPA would be damaged.

The solution for busy seasons isn’t staffing up with claims specialists. It’s using technology to offload as much of the manual and clerical work as possible. This allows you to focus on strengthening your relationships with brokers, employers, and participants. Customer satisfaction across all three of these key audiences is itself a tool in your sales kit, so make sure you’re protecting it through efficient — and automated — EOB harvesting.

EOB Processing is at the Core of Your Success — Make It Count

You know better than anyone else the importance of the EOB. It’s the core function of what you offer, and it’s also the key to the growth and success of your business. If you haven’t given EOB processing the attention or automation it needs, now is the time. 

The healthcare industry is in a constant state of change. Employers are changing plans, and more and more people are receiving care as the U.S. population continues to age. And throughout it all, brokers will be leaning on you to be the ones that save the day when they recommend you to a new organization. 

Ready to learn how TPA Stream can give you the tools you need to achieve success in the months and years to come. Contact us today.

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