Understanding the Strategic Importance of the TPA Relationship

tpa relationship

When It Comes to a TPA Relationship, We’ve Said It Before, and We’ll Say It Again

You are a relationship business. While most of your work goes on behind the scenes, it all goes toward creating a positive experience and a successful result for plan participants, employers, and the brokers that introduced you. All three audiences (there are others, too, like advisors and other companies you partner or integrate with) are counting on you to follow-through — not just down the road once things get up and running, but immediately.

Before we put too much pressure on you, we should acknowledge that a successful relationship isn’t dependent on you alone. The best TPA relationship will be a strategic partnership with all parties involved. There need to be realistic expectations around the arrangement between TPA, the employer, and its participants. While you’ll likely have some KPIs and goals assigned to you that you need to hit, it’s perfectly fair to require accountability on the part of your clients, too. These will help set those realistic expectations from the start, ensuring that everyone knows what’s needed for success.

Here, we’d like to explore these three key audiences and what you should focus on to create a strong and lasting partnership in each one. Let’s get started.

Brokers: They’re Your Hero, So Be Their Hero, Too

Brokers are one of the best and fastest ways to get your foot in the door with a new organization looking for third party administration. While you should always have your own sales efforts, the use of channel partners, referral partners, and so on often lead to easier sells. They’re putting their established identity and reputation on the line in front of a new client by referring you (that they have just as much a chance of losing as you do), so it’s important to get involved and stay involved from the start.

As we mentioned above, it’s important to be in those meetings alongside your broker or a plan advisor — not only to back them up and answer any questions the client may have but also to protect your organization by setting those expectations. Brokers are not TPAs, and TPAs are not brokers. By working together, you can collaboratively express your value to the client and close more deals.

And remember, when the deal is closed and those EOBs start rolling in, you need to prove your worth quickly. This is important at the start of the relationship because you’ll be introducing yourself to plan participants and getting set up with insurance carriers. 

Employers: The Ones Caught in the Middle

Let’s set the stage: the broker brings you in on a new opportunity with a nationwide mortgage firm looking for better plan options. They’re a $7 billion company with 2,500 employees across the country. Once the sales cycle is complete and the deal is done, their benefits and HR teams will be looking to you for leadership on the rollout.

Things go well for a while, and then Q4 rolls around. Medical claims start increasing significantly. Despite having state-of-the-art systems, much of your process is still manual in the sense that your team is getting documentation via email and even faxes. While this one company isn’t itself the issue, you have an entire portfolio of companies relying on you for efficient service — and year-end is drawing closer and closer. The claims influx increases every day, and your turn-times are starting to slip — badly.

The mortgage company’s HR department is fielding a number of calls from across the country on a daily basis from upset employees asking what’s going on. The HR department, confident in your abilities, hasn’t kept a tight hold on you (they didn’t need to, remember — you sold them on efficiencies to handle high volumes). Frustrated with your turn times, they contact the broker. Now, your broker — whose primary concern is closing the deal and moving on knowing you have it under control — is pressuring you to perform. 

Do you think they’re going to bring you in on their next opportunity?

Participants: Every Single Interaction is an Opportunity

While we’d love to say you’ll never upset a single plan member, it happens. But, your starting point for success should be 100% customer satisfaction. No backtracking, no down sliding. Start off strong and stay strong in each and every interaction.

Remember that when it comes to submitting EOBs for substantiation and reimbursement, plan participants might not exactly know what that is or what to do with it. This is where an automated solution will be useful to automatically retrieve this documentation from the insurance carrier on behalf of the participant. This simplifies the process, takes the stress and burden off the participant’s plate, and makes it entirely electronic.

Automation is also key during busy times. There’ll still be work to be done when the volume is higher, but automation will go a long way in eliminating the manual processes and administrative tasks associated with EOB processing.

In all things, remember that a successful TPA relationship starts with plan participants. If you can’t uphold your end of the deal for them, employers and eventually brokers will be informed. These are two sources of revenue and growth for your business. And all it takes to keep them happy is to keep their participants happy.

Put Technology to Work to Create a Successful TPA Relationship

A lot goes into your TPA relationship with brokers, employers, and participants. But the key to long-term success is keeping the wheels well-oiled and turning. By using a platform like TPA Stream, you can automate virtually every aspect of the EOB process — eliminating worry and confusion in participants, reducing the hassle and pressure for employers, and solidifying trust and results for your broker partners.

Learn how TPA Stream can help you take your business to the next level.

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Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better healthcare outcomes for employers and their employees.

Learn more about TPA Stream here.

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