Many small and medium-size TPAs find it difficult to compete against larger competitors, HMOs and health insurers that offer deep provider discounts, sophisticated cost management techniques, broader product lines, and the latest technological advancements to reduce their cost of operation. And, while the inability of TPAs to obtain adequate client fee increases has severely depressed profits, inevitably we find that many TPAs do not take advantage of all of the means available to increase their revenues and reduce their costs.
TPA Network performs profit optimization audits of TPAs that are designed to identify ways by which revenues may be enhanced, profits increased, and expenses reduced. The following are some of the areas upon which we focus. Please note that these are just some of the products, services and technologies that TPA Network has identified as cost reduction and revenue generators for TPAs. In most cases, our arrangements enable payors to access these vendors on terms that are more advantageous than if they negotiated them directly:
o claim data capture,
o database and record management,
o backend check and EOB processing,
o non-network claims management,
o pharmacy benefit management,
o decision support & benefit intelligence,
o multi-year program funding,
o outsourcing,
o consumer-driven healthcare,
o fraud & abuse, error and overpayment detection, and
o subrogation and coordination of benefits services.
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