TPA Network has been at the forefront of innovation in the TPA industry since 1985. Indeed, our experience dates back to the beginning of the health insurance industry, some 45 years ago.
Principals of our firm have helped to shape and develop some of the earliest forms of group health insurance in the '60s. We were there in the '70s and '80s when the TPA industry took hold and expanded rapidly. When federal legislation threatened to make the industry more cumbersome, we represented hundreds of TPAs (and millions of plan participants) at hearings before the U.S. Congress. We have counseled governments and think tanks, published numerous articles, and spoken extensively on topics of interest and concern to TPAs, health insurers and managed care organizations.
TPA Network's principals and network of experts include professionals with a wide variety of backgrounds and decades of hands-on experience in the design, operation, management and marketing of large-scale administrative operations both in the U.S. and offshore, including extensive experience working with both small and large-scale health insurers, TPAs, HMOs and other healthplan administration entities. Our principals and associates have started and operated TPAs, managed care organizations, and business process outsourcing firms, both in the U.S. and abroad. Over the years our clients have included a diverse group of health insurers, HMOs, and Fortune 500’s with names such as Prudential, Fidelity Insurance Group, Xerox, New York Life, UNYSIS, the American Healthcare Association, General de Seguros, and Computer Sciences Corporation. We have advised and represented several allied service vendors to the industry and have performed numerous research, consulting, valuation and merger and acquisition assignments. And because we have business and/or personal relationships with the principals and executive management of more than 200 TPAs, PPOs, HMOs, and health insurers we are often called upon to facilitate introductions and negotiate deals.
As described herein, TPA Network performs consulting assignments, operational reviews and audits, effects mergers and acquisitions, raises capital, evaluates and designs products and services, assists in business development, and helps to establish channels of distribution for emerging products, services, and technologies.
The profiles of TPA Network's principal consultants follow:
Nicholas Cole
Nick Cole helped pioneer the health insurance industry in 1960 at Connecticut General Life Ins. Co. (now CIGNA). In 1962, Nick helped establish the Massachusetts General Life Insurance Company (a unit of the world-renowned hospital) where he hired and trained several people who later went on to build some of the country’s largest TPAs. Nick was in management at the Bankers Life of Des Moines (now Principal Financial Group) then spent a few years in the aviation and hotel industries. Nick returned to the benefits industry to lead the marketing efforts of Group Administration Support Products and in 1985 he founded TPA Network, which was soon engaged by Computer Science Corporation to introduce the concept of outsourcing to TPAs. Over the years, Nick has facilitated many TPA mergers and acquisitions and was among the first to bring document conversion services to TPAs with eClaimScan, LLC.
Richard L. Nicholas
Richard Nicholas has 30 years of experience in the health insurance, employee benefits and managed care industries. He has served as Sr. Vice President of both ALTA Health Strategies (the country's largest TPA at the time) and UltraLink, Inc. (the first national HMO network manager). He was Chief Consultant at FHP Healthcare (then the 5th largest HMO in the U.S.) and an advisor to Prudential, NYLCare, Xerox, UNYSIS, CSC and the Mexican government. Richard helped pioneer managed care in México and he owned and operated a México-based claims outsourcing firm that supported U.S. health insurers, HMOs and TPAs. He is the author of several articles, papers and a book on corporate healthcare cost management, and he has represented 200+ TPAs at hearings before the U.S. Congress, Committee on Ways & Means.
Michael Shine
Mike Shine began his professional career more than 30 years ago with the Travelers Insurance Company where he developed a working knowledge of claim processing workflows and supervised and managed group medical, Medicare, disability and workers’ compensation claim teams. In 1986, Mike established the first cost containment programs at the CNA Insurance Company and managed the 500,000-employee Mail Handlers Benefit Plan, the largest single federal employees benefits program. With a staff of 400 employees (and responsibility for claims, customer service, medical review, managed care, cost containment, and information systems) he processed 18,000 claims and 3,000 calls per day. Most recently, Michael has held executive management positions with First Health/Alta Health Strategies, Brokerage Concepts and Performax where he designed and implemented leading-edge operations programs and solutions.
Ron Lang
Ron Lang has been involved in the employee benefits, healthcare and P & C insurance industries for more than 20 years having served in senior executive capacities at several major TPAs and insurers (including the insurance and TPA operating units of FHP/PacifiCare and Industrial Indemnity/Xerox).
An expert in all aspects of finance, operations and systems he has designed and implemented numerous operational, financial and IT infrastructures for healthcare, benefits and P & C carriers and TPAs. Ron is a pioneer in transactional e-business insurance applications that include electronic billing, (EBPP), loss reporting and customer self services. Over his career Mr. Lang has been an innovator in the development of new products, including integrated benefits programs, niche products/programs and cost containment techniques. From underwriting, through policy administration, to claims, and producer management, Ron has the skill set, expertise and experience to address any strategic, operational, compliance or audit scenario.
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