An increasing number of ERISA plan failings, TPA bankruptcies and botched acquisitions have left thousands of Plan Participants in the lurch and unnecessarily placed many TPAs, Benefit Consultants and Plan Sponsors on the wrong side of the US Department of Labor. Our unique service helps Plan Participants deal successfully with an unexpected service interruption….ensuring continuity of care, saving money and preserving reputations.
Whenever an unexpected interruption of plan administration services occurs – whether by an IT glitch, funding shortfall, bankruptcy, merger or boardroom or courtroom confrontation – it is the Plan’s Participants who suffer the most, not the creditors, employees, providers or investors.
The high cost of sponsoring a healthcare plan, coupled with a stagnant economy, have caused many benefit plans and TPAs to fail, merge or otherwise interrupt regular service delivery. In such cases, Plan Participants are often left with unprocessed medical claims, the inability to access healthcare services and the need to pay for services in advance to avoid damaging their credit rating – all this while they are ill, stressed and the least able to deal with our complex medical system. In situations like this, Plan Participants need a friend experienced with the healthcare maze? We are that friend.
Service interruptions typically evolve quickly and test the mettle of even the most experienced leaders. They pose a threat to your organization and put your reputation at risk. Situations like this also present an opportunity to showcase your organization's character and its commitment to its promise and values. And, given that most plans are ERISA-based and under the oversight of the U.S. Department of Labor, it is wise to remember that your actions must always be for the exclusive benefit of the Plan Participant.
TPA Network has been a pioneer, advocate and leading player in the TPA industry for more than three decades. We have a deep understanding of the industry, a track record of success...and a client list that would make anyone envious. To address the uptick in service interruption situations, we developed Emergency Administration Support Services to serve Plan Participants and assist Plan Sponsors, TPAs and Benefits Consultants. Our service is designed to provide continuity when it does not exist; and to containment negative publicity and reputational and financial threats. Custom designed to address each unique situation; the scope and nature of our services take different forms for different situations.
Our team of professionals has experience and expertise across all phases of the service interruption lifecycle. We have brought together the talents of doctors, nurses, lawyers, social workers and other healthcare professionals, TPA owners and insurance specialists, to ensure that Plan Participants get the best healthcare possible and the most from their plan. Our skills and the proven, proprietary techniques, methods and tools we employ help Plan Sponsors, TPAs, Benefits Consultants and Plan Participant groups identify, assess, understand, manage, respond to and cope with almost any type of plan administration service delivery interruption…. from the moment it first occurs to recovery.
The following are just some of the elements of our Emergency Administration Support Services:
Immediate response – ready to deploy within hours of notice of a service interruption.
Situational assessment – the identification and assessment of the service interruption situation to gain a better understanding of the specific issues at hand.
Project planning – the development of an action plan to manage and respond to the situation.
Issue resolution – actions to directly help Plan Participants cope with the service interruption:
establish toll-free hotline to address Plan Participants, providers, etc.;
launch targeted communications, stakeholder outreach and controlled messaging programs using social and traditional media, designed to both take command of the situation and preempt reputation threats;
create an individual “folder” for each impacted Plan Participant on special, proprietary software designed specifically for these types of situations;
collect, inventory, image and index all claim submissions;
compile a database of all submitted and settled paid claims;
sort, review and audit all bills submitted to determine if there are duplicates, contain unbundled charges, are medically necessary or have billing errors;
determine what is covered by the plan and provide Plan Participant with a simple, easy-to-understand statement that clearly explains what is owed;
tie past claim payments (checks, credit card charges) to the database above;
negotiate bills at fair market value with the provider and advise client;
submit a claim on Plan Participant’s behalf or otherwise facilitate payment;
Accountability – provide client with a claim image library, a report and a comprehensive database tying to and accounting for all claims submitted and payments.
Analysis – study and evaluate all data collected, which can be integrated with a client’s own proprietary data, to provide greater situational awareness and insight.
Each service detailed above is designed, coordinated and approved in advance by the client.
Whether the Plan Participant is covered under a insured or self-funded traditional indemnity plan; HMO, Medicare or MediGap plan, we have the expertise and experience to handle the situation.
For more info about our Emergency Administration Support Services contact Richard Nicholas at (858) 395-4114 (between 10 AM and 5 PM PST) or by email at Richard@tpanetwork.net.
Successfully helping forward-thinking TPAs achieve their goals -- since 1985