TPAs are stuck in a web of manual claims tasks that lack efficiency. Automation can help. Learn the 4 steps TPAs need to take before they can process claims more efficiently with automation.
As a Third-Party Administrator (TPA), you’re pulled in a lot of directions.
Your first objective is to support your clients by processing claims and improving their claims’ outcomes.
Next, and maybe even most importantly, you are face-to-face with the end-user, or the claimants and their families on a daily basis, with the goal of moving their claims through your internal process — quickly. The communication necessary to do this successfully assumes an extra layer of complexity when your service is white-labeled, requiring different client-facing language and policies.
And, if the business’ broker was your referral partner, then you’ve got to keep them happy, too, so that you’re top of mind when they’re brokering their next deal.
Although very different, these three disparate parties — together with you, the TPA —have the same ultimate goal: to process claims efficiently.
Sounds simple, right? Unfortunately, more often than not, processing claims efficiently is anything but simple.
The claims process, when done manually, is haphazard at best. Much of your days are spent retrieving and attaching PDFs to and from emails, sending information via fax, forwarding on notifications and pulling data from numerous places to create reports and move claims onto the next stage.
Whether you’re working in spreadsheets or a slightly more user-friendly reporting program, chances are the process you’re using to move claims to resolution is still highly inefficient.
Imagine if you could automate the entire claims process, streamlining manual work by creating a single process for document management that allows you to attach files directly to claims and move them through to resolution, 100% digitally?
The good news is you can – by engaging automation.
But, before you can automate your claims process, you’ve got to get your back-of-house in order.
Adding automation to a weak process won’t make it any stronger. In fact, it’ll just further systematize the weakness.
Before you upgrade to an automated process, it’s critical to get all your ducks in order by building a robust infrastructure that can support automation. When you make the leap, having the back-end work done ahead of time will make all the difference.
Here are the 4 critical steps necessary to get your TPA business ready to implement claims automation across your business.
Bridging the gap from manual to automated isn’t easy. It takes time, a team of dedicated individuals and a period of trial and error optimization. The challenge for TPAs will be twofold. One, trying to maintain an existing workload while overhauling the very claims management system you’re working in simultaneously. And two, doing so while keeping employees, clients and carriers happy.
And yet, we all know that process improvements only come from dedication and the willingness to do and see things differently in the name of efficiency, productivity and optimal outcomes.
For more information on automating your claims management program with claims management software, contact Leslie Sargent, Ventiv’s TPA practice leader.
Learn how Tribal First, the largest provider of insurance solutions to Native American Tribal Nations, automated their claims process.