The Benefits of Direct Pay Provider Network to Third Party Administrators

Stethoscope on calendar page. Regular medical examination concept.

A Third Party Administrator (TPA) is an enterprise whose main line of business is to process the insurance claims or other benefit plans of employees of another entity. In modern business, this is considered as outsourcing of the claims processing administration since a third party administrator performs tasks typically handled by the company providing the insurance.

TPA workers comp companies are business organizations that work in the healthcare industry. They are usually the ones contracted by health insurers or self-ensuring companies to perform services which includes administrative work involved in the workers compensation claims process. A TPA may work for an insurance company by coordinating with its medical providers in order to expedite the latter’s claims. They also perform other services an insurer normally provides its clients with.

Companies that self-insure their employees usually use the services of a Third Party Administrator to perform these functions:

  • Review claims filed by employees to make sure that these are valid and eligible for processing
  • Directs sick or injured policy holders to a hospital that is a member of the insurance company’s medical provider network
  • Provide sick or injured policy holders with an authorization letter to be presented to the medical care provider. This signifies that the transaction is acknowledged by the insurer, and the discharge bills are eligible for sending to the TPA for the processing of payment.
  • Check and send to the insurer, all documents required for the approval of the claims, including bills.

These are just a few of the responsibilities a third party administrator has to tackle to make sure that an insurer’s policy holders are promptly accommodated when they need medical care due to sickness or injury. A delay in the process can cause the sickness or injury to get more serious and difficult to manage. This can result in added medical costs, longer healing time, or even death. All of these can mean loss not only to the company but to the policy holder’s family as well.

For this reason, it would be prudent for third party administrators to consider forging a partnership with a competent medical scheduling provider like Direct Provider Network.

These are some of the salient benefits Direct Pay Provider Network can deliver to Third Party Administrators:

  • Direct Pay Provider has extensive knowledge and experience in the insurance and medical fields
  • We are well-versed with the complexities of processing medical insurance and workers’ compensation claims of sick or injured workers
  • We can facilitate efficient medical scheduling because of our big network of medical providers nationwide. This can help to speed up the recovery of injured or sick workers
  • Early recovery of patients means early hospital discharge, lesser hospitalization costs and earlier return to work. This helps to make the patient productive again.
  • We do all the legwork, processing, billing and reporting jobs to facilitate speedy transaction for the fast and seamless hospitalization, rehabilitation and discharge of injured policy holders.
  • We can help to make your job easier and your patients’ bill charges lower by as much as 65%.

As a workers comp third party administrator, you should take advantage of our industry experience and skills. Our knowledge in all areas of TPA workers comp processing and  medical scheduling can certainly help to keep your costs lower and ROIs higher.