Overview of Independent, Active Plan Management & Oversight

Deciding what gets paid and at what level may seem simple at first glance and yet sweating the details of these decisions is what determines plan performance. Your clients need a strong advocate with robust processes to ensure only the right claims are paid and at the agreed upon price, while also minimizing disruption and confusion for the plan member and providing timely reimbursement to the health care provider. It is also extremely important to ensure that the TPA’s incentives are aligned with the sponsor’s — the TPA’s fees should not increase when claims costs increase.

The first decision you’ll make is between an ASO and an independent TPA. Please read and review Independent Claims Administrators vs. Insurance Carrier Owned Claims Administrators – The Trade-offs below.