Why Use A TPA
WHY USE A TPA?
Third-party administrators handle many aspects of employee benefit plans such as medical, dental and vision claims processing, the processing of retirement benefits and flexible spending accounts. Many employee benefit plans have highly technical aspects and difficult administration that can make using a specialized entity such as a TPA more cost effective than doing the same processing in house.
What is a TPA?
A person or organization that processes claims and performs other administrative services in accordance with a service contract, usually in the field of employee benefits.
The Value of a TPA
• Claims handling experience
• All employee information resides in one place
• Access to multiple specialty carriers
• An Employee Benefit Systems administered self-funded program establishes:
– Increased financial control
– Lower operating costs
– Flexibility with plan design
– Choice of networks
– Detailed reporting of plan usage, claims data, and effective cost management
Choose a TPA to:
• Manage the Processing of Claims
• Manage Flexible Spending Accounts
• Manage Self-Funding Accounts
• Manage Carrier Website Enrollments
• Manage Premium Collection and Payments
• Manage Life Insurance Claims
• All other Administrative activities
Virtual Benefits Administrator (VBA) is a pro-active, leading edge software design company providing custom solutions to the insurance industry for nearly 20 years. Uniquely delivered on a secure, cloud-based architecture, VBA provides one-common-architecture for all Employee Benefit Administration. Our software development process focuses on continuous improvement to address the requirements in the ever-changing healthcare industry. This empowers our clients to focus on business strategy and growth while streamlining their operations.
VBA is designed to allow you to administer any line of business using unlimited flexibility and robust functionality utilizing the latest in cloud-based technology. VBA’s motto is continuous improvement and we’re constantly improving VBA. Users and members all play an important part in that continuous improvement process through our SCRUM development methodology. You will benefit from those improvements into the future because you will always be using the best system available.
Flexibility is the hallmark of our system. VBA’s architecture provides flexibility that empowers users with the ability to make changes and adjustments to respond to market demands easily and efficiently.
VBA’s Functionality is comprehensive and user friendly. Users can navigate quickly and easily throughout the system to get all of the information they need in a matter of seconds. This translates into time savings and improved customer service.
VBA Technology is leading edge and takes advantage of the efficiency and scalability of Smart Client Technology and Offline Adjudication.
VBA’s Medical application maintains both professional and institutional claim types with all required information. VBA incorporates thousands of built-in edits to verify and validate data in regards to eligibility, coordination of benefits, individual and family limitations, plan maximums, standard and custom benefit definitions, and accumulator data for current plan year and history plan years. A myriad of pricing capabilities include: FFS, Per-Diem, DRG, Custom Provider Rate, Adjusted Discount, and General Discount.
VBA easily administers medical claims ranging from Medicare to Medicaid to Commercial brands using complex or simple plans defined through the Plan/Benefit Module.
VBA’s Dental module maintains cost containment edits flexible enough to process all CDT Dental code requirements. VBA allows you the ability to track tooth activity on enrollment records with full tooth charts for both primary and permanent teeth. Users can easily identify crowns, bridges, and extractions to improve customer service while automatically impacting claims payment. VBA’s auto-adjudication allows for customized rules through plan setup with maximums by arch, quadrant, or a defined set of teeth within a defined set of dental procedures.
Life & Disability
VBA’s Life & Disability module provides for easy administration of Short-Term Disability, Long-Term Disability, AD&D, Supplemental Life, Voluntary Life, Living Benefit, and more. VBA can fully administer any form of disability benefit and allows for benefit definitions by salary percentage or flat rate while applying all the appropriate taxes. Our Disability Payment Creator takes all disability information and determines the appropriate payment structure accounting for waiting period, salary continuation, sick pay and more. All payments are created in advance and the VBA Repetitive Pay process will assure you do not miss a payment to your members. Our Life Payment Creator takes all life claim information and determines the appropriate payment structure based on beneficiary split and benefit volume.
FSA - HRA - HSA
VBA’s FSA-HRA-HSA module provides for an extremely flexible approach to managing pre-tax Section 125 Cafeteria, Section 129 Dependent Care Assistance and Section 132 Qualified Transit Plans. VBA allows members to have multiple plan accounts at one time with reimbursements paid from the appropriate account. You can track all aspects of a Flex Plan including submission periods, grace periods, employee/employer contributions, minimum and maximum elections, and balances. VBA administers all lines of business on a single platform which allows for automatic creation of flex payments based on member responsibility received on medical, dental or RX claims.
VBA’s PBM Administration module provides for tracking of all incoming pharmacy information (EDI or otherwise) including Drug Code, Prescription Date, Fill Date, Quantity, Prescription Number, Refill/Generic Indicators as well as member responsibility and the actual prescription amounts. You can build specific benefits using the Dynamic Plan and Benefit Module allowing for user-defined restrictions (such as experimental drugs) or pricing modifications to monitor and manage member responsibility.
VBA’s Reinsurance module provides for reinsurer/stop-loss tracking at the policy level with a great deal of flexibility, including stop loss tracking and reporting at the member level. VBA allows all information specific to each stop-loss contract – contract length, lasers, coverage exclusions based on benefit and procedure codes – to be held at the Group, Division or Subscriber level. Easily create aggregate reports, stop loss notifications, receivable tracking information, and claim details using a comprehensive reporting interface that leverages our industry-leading claims framework.
With the VBA Premium Billing module you can construct dynamic rate structures and generate invoices at the Group, Division, or Employee level. Billing is processed a variety of ways including Tier, Age/Sex, and Adult/Child allowing for dynamic invoicing between Divisions within a Group or even down to the Plan within a division. Streamlined rate setup allows you to quickly modify existing rates, copy rates, or add new rates utilizing a template-based approach for simplicity. Individual billing allows for premium processing at an individual level which is independent of defined rates at the Employer Group or Division Level. With VBA, invoices are automatically retro-adjusted when enrollment information or existing rate is changed assuring the accuracy of subsequent invoices.
Utilize the VBA commission module to simplify the agent/agency payment process. The VBA commission module has the ability to generate commissions based on PEPM, PMPM, percent of premiums billed or percent of premiums received as defined at the Group, Division or Plan level. VBA has the flexibility to pay commissions to any number of agents as well as the ability to set the percentage split on commissions paid by user-defined entries. Each split can be tiered such that any payment hierarchy can be accommodated. You can define any number of agents per agency or independent agents and provide specific information such as EO Coverage Name, EO Coverage level and much more.
.... AND MORE
We offer updated technology, including a Gateway for stress-free enrollments.
We also offer Bennie cards, for your Flex spending needs. The advantages of the Bennie card are:
~ Cashless transactions - instead of paying for eligible expenses and waiting to be reimbursed, the debit card pays the expense directly from your Medical or Dependent Care Account.
~Some debit card transactions may require receipt verification
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