Questions to ask your third-party administrator

Working With a Third-Party Administrator? Ask These Questions

Communication is the key to any strong relationship, and that goes for your third-party administrator (TPA), too. Whether you just started working with a TPA or want to ensure your existing collaboration remains strong, it’s critical to keep your interactions on track.

 

Here are a few tips to ensure you and your TPA are speaking the same language.

 

Why TPA communication matters

A TPA is responsible for some of the most important parts of your business: employee healthcare experiences. To get the outcomes you want at the prices you need, you must always have open communication with your TPA. That doesn’t just mean emails and the occasional phone call; you have to approach with a strategy for ongoing collaboration.

 

TPA interactions should be built on three main elements:

 

• Goals: What do you want out of this relationship and what can the TPA do to help you get there?
• Expectations: What are your responsibilities and how do they influence what the TPA is legally required to deliver?
• Results: What does success look like and how should you measure it? How will you keep track of the TPA relationship?

 

When working with a TPA, each party must understand what the other needs and wants. Consistent, clear communication is so important because it’s the only way to ensure your TPA isn’t trying to read your mind (and likely missing the mark).

 

The best way to approach TPA collaboration is to build a partnership. Remember that health plans are complicated — and, for your employees, both critical and potentially stressful. Your TPA can help address all the parts of this experience that might be a struggle to tackle alone, but only if you build communication on trust and responsiveness.

 

Questions to facilitate TPA communication

To effectively collaborate with your TPA, it’s helpful to have targeted, strategic questions ready to go. Here are a few examples:

 

“What do your fees cover?”

This question is best asked at the beginning of your TPA relationship, but it can also help clear up confusion or refocus expectations further down the road. Your TPA should explain exactly what they do and how they charge for it so you get a better understanding of the relationship overall. It’s also a good way to get the background information necessary to track return on investment (ROI) and justify certain services to decision-makers.

“How do you handle compliance?”

Healthcare compliance can change rapidly, and if your plans aren’t flexible enough to keep up, you could face fines, disciplinary action, and more. Your TPA needs to have a strategy for shifting, updating, or restructuring its offerings to keep you protected.

 

“What training resources are available?”

A TPA should provide support at many levels of the healthcare experience. If they don’t volunteer training materials or other resources, ask about the best ways to get your employees and decision-makers up to speed on the latest processes.

 

“How do you utilize our data?”

Although you should understand privacy policies and related agreements right away, other parts of data utilization might become clear only over time. It’s important to understand how your TPA views data: what it gathers, what it extracts from that information, and how it acts on relevant insights. It’s particularly relevant if you’re utilizing Population Health Management or similar services that respond to patterns in health behaviors and risks.

 

“What do you need from us?”

When you ask this question, you help build trust with your TPA. You indicate that you’re taking action in the relationship and working proactively to avoid issues, simplify interactions, and empower the best outcomes. You’re also creating opportunities to eliminate bottlenecks and overcome delays in the future.

 

“What other services can you provide?”

As time goes on, your TPA will learn more about who you are, what you do, and what your employees need. As a result, your TPA will be in a strong position to identify gaps in your benefits or processes. Once the relationship is established, you should trust your partner enough to solve those problems. Your TPA should be enthusiastic to grow its relationship with your organization.

 

Final thoughts

Communicating with your third-party administrator should be a priority. It doesn’t just help you get the outcomes you expect; it also ensures you’re getting more — more personalized service, more targeted solutions, more effective processes. Although communication is, as in any other relationship, a two-way street, it’s often helpful to prepare questions that help facilitate collaboration.

 

Want a strong TPA relationship? MagnaCare can make it happen. Contact us at [email protected].