{"id":1006,"date":"2021-07-14T11:12:04","date_gmt":"2021-07-14T11:12:04","guid":{"rendered":"https:\/\/ighcp.com\/ebs\/?page_id=1006"},"modified":"2021-07-26T11:31:03","modified_gmt":"2021-07-26T11:31:03","slug":"why-use-a-tpa","status":"publish","type":"page","link":"https:\/\/ighcp.com\/ebs\/employers\/why-use-a-tpa\/","title":{"rendered":"Why Use A TPA"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||0px||false|false&#8221;][et_pb_row module_class=&#8221;inner_top_heading&#8221; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#5e5e60&#8243; background_image=&#8221;https:\/\/ighcp.com\/ebs\/wp-content\/uploads\/2021\/07\/bg-grey.png&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221;][et_pb_text module_class=&#8221;heading_top&#8221; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;|600|||||||&#8221; text_text_color=&#8221;#ffffff&#8221; text_font_size=&#8221;36px&#8221; header_text_color=&#8221;#ffffff&#8221; custom_padding=&#8221;|||20px|false|false&#8221;]<\/p>\n<p>Why Use A TPA<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_3,2_3&#8243; module_id=&#8221;main_inner_section&#8221; module_class=&#8221;main_inner_section&#8221; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;||40px||false|false&#8221;][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221;][et_pb_text module_class=&#8221;inner_left_menu&#8221; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;Open Sans|700|||||||&#8221; text_font_size=&#8221;20px&#8221; text_line_height=&#8221;26px&#8221;]<\/p>\n<ul>\n<li><a href=\"https:\/\/ighcp.com\/ebs\/employers\/\">Employers<\/a><\/li>\n<li><a href=\"https:\/\/ighcp.com\/ebs\/members\/\">Members<\/a><\/li>\n<li><a href=\"https:\/\/ighcp.com\/ebs\/providers\/\">Providers<\/a><\/li>\n<li><a href=\"https:\/\/ighcp.com\/ebs\/producers\/\">Producers<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;rgba(0,0,0,0)&#8221; min_height=&#8221;30px&#8221; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;||0px||false|false&#8221; link_option_url=&#8221;https:\/\/ighcp.com\/ebs\/services\/&#8221; background__hover_enabled=&#8221;on|hover&#8221; background_color__hover=&#8221;#0e76bc&#8221; background_enable_color__hover=&#8221;on&#8221;][\/et_pb_text][et_pb_image src=&#8221;https:\/\/ighcp.com\/ebs\/wp-content\/uploads\/2021\/07\/Monthly-250&#215;250-1.gif&#8221; title_text=&#8221;Monthly-250&#215;250&#8243; url=&#8221;https:\/\/fsastore.com\/?a_aid=50d376bcb7451&#038;a_bid=5088e631&#038;utm_source=Employee+Benefit+Systems&#038;utm_medium=TPA+Banner&#038;utm_campaign=TPA+Partner&#8221; align=&#8221;center&#8221; _builder_version=&#8221;4.9.10&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; border_color_top=&#8221;#0e76bc&#8221; url_new_window=&#8221;on&#8221; sticky_enabled=&#8221;0&#8243;][\/et_pb_image][\/et_pb_column][et_pb_column type=&#8221;2_3&#8243; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|40px|||false|false&#8221;][et_pb_image src=&#8221;https:\/\/ighcp.com\/ebs\/wp-content\/uploads\/2021\/07\/274994_l_srgb_s_gl13-600&#215;635-1.jpg&#8221; title_text=&#8221;274994_l_srgb_s_gl13-600&#215;635&#8243; module_class=&#8221;main_inner_section_img&#8221; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221;][\/et_pb_image][et_pb_text _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; header_2_font=&#8221;Open Sans|600||on|||||&#8221; header_2_text_color=&#8221;#0e76bc&#8221; header_2_font_size=&#8221;28px&#8221;]<\/p>\n<h2>WHY USE A TPA?<\/h2>\n<p>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.<\/p>\n<p><strong>What is a TPA?<\/strong><br \/>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.<\/p>\n<p><strong>The Value of a TPA<\/strong><br \/>\u2022 Claims handling experience<br \/>\u2022 All employee information resides in one place<br \/>\u2022 Access to multiple specialty carriers<br \/>\u2022 An Employee Benefit Systems administered self-funded program establishes:<br \/>\u2013 Increased financial control<br \/>\u2013 Lower operating costs<br \/>\u2013 Flexibility with plan design<br \/>\u2013 Choice of networks<br \/>\u2013 Detailed reporting of plan usage, claims data, and effective cost management<\/p>\n<p><strong>Choose a TPA to:<\/strong><br \/>\u2022 Manage the Processing of Claims<br \/>\u2022 Manage Flexible Spending Accounts<br \/>\u2022 Manage Self-Funding Accounts<br \/>\u2022 Manage Carrier Website Enrollments<br \/>\u2022 Manage Premium Collection and Payments<br \/>\u2022 Manage Life Insurance Claims<br \/>\u2022 All other Administrative activities<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221;]<div id=\"accordions-1008\" class=\"accordions-1008 accordions\">\r\n                <style type='text\/css'>\r\n        @media only screen and (min-width: 1024px ){\r\n            #accordions-1008 {\r\n                            width: 100%;\r\n                        }\r\n        }\r\n        @media only screen and ( min-width: 768px ) and ( max-width: 1023px ) {\r\n            #accordions-1008 {\r\n                            width: 100%;\r\n                        }\r\n        }\r\n        @media only screen and ( min-width: 0px ) and ( max-width: 767px ){\r\n            #accordions-1008 {\r\n                            width: 100%;\r\n                        }\r\n        }\r\n        #accordions-1008 {\r\n                            text-align: left;\r\n                                        background:#ffffff url() repeat scroll 0 0;\r\n                                    position: relative;\r\n        }\r\n        #accordions-1008 .accordions-head{\r\n                    background:#1e73be none repeat scroll 0 0;\r\n                                    outline: none;\r\n        }\r\n        #accordions-1008 .accordions-head-title{\r\n                            color:#ffffff;\r\n                            font-size:20px;\r\n                }\r\n        #accordions-1008 .accordions-head-title-toggle{\r\n                    color:#ffffff;\r\n                            font-size:20px;\r\n                }\r\n        #accordions-1008 .accordions-head:hover .accordions-head-title{\r\n                    color:#f58220;\r\n                }\r\n        #accordions-1008 .ui-state-active{\r\n                    background: #ffffff;\r\n                    border: none;\r\n        }\r\n        #accordions-1008 .accordion-content{\r\n                            background:#ffffff none repeat scroll 0 0;\r\n                                                    border: none;\r\n        }\r\n        #accordions-1008 .accordion-icons{\r\n                        color:#2e3192;\r\n                                                                    }\r\n        #accordions-1008 .accordions-head:hover .accordion-icons span{\r\n                        color:#2e3192;\r\n                    }\r\n            <\/style>\r\n    <div class=\"items\">\r\n                        <div post_id=\"1008\" itemcount=\"0\" header_id=\"header-1626158479471\" id=\"header-1626158479471\" style=\"\" class=\"accordions-head head1626158479471  tab\" toggle-text=\"\" main-text=\"Technology\">\r\n                                            <span id=\"header-text-1626158479471\" class=\"accordions-head-title\">Technology<\/span>\r\n                        <span id=\"accordion-icons-1626158479471\" class=\"accordion-icons\">\r\n                            <span class=\"accordion-icon-active accordion-plus\"><i class=\"fas fa-chevron-up\"><\/i><\/span>\r\n                            <span class=\"accordion-icon-inactive accordion-minus\"><i class=\"fas fa-chevron-right\"><\/i><\/span>\r\n                        <\/span>\r\n                                        <\/div>\r\n                <div class=\"accordion-content content1626158479471 \">\r\n                    <h4>VBA Software<\/h4>\n<p>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.<\/p>\n<p>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\u2019s motto is continuous improvement and we\u2019re 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.<\/p>\n<h4>Flexibility<\/h4>\n<p>Flexibility is the hallmark of our system. VBA\u2019s architecture provides flexibility that empowers users with the ability to make changes and adjustments to respond to market demands easily and efficiently.<\/p>\n<h4>Functionality<\/h4>\n<p>VBA\u2019s 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.<\/p>\n<h4>Technology<\/h4>\n<p>VBA Technology is leading edge and takes advantage of the efficiency and scalability of Smart Client Technology and Offline Adjudication.<\/p>\n<h4>Medical<\/h4>\n<p>VBA\u2019s 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.<\/p>\n<p>VBA easily administers medical claims ranging from Medicare to Medicaid to Commercial brands using complex or simple plans defined through the Plan\/Benefit Module.<\/p>\n<h4>Dental<\/h4>\n<p>VBA\u2019s 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\u2019s 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.<\/p>\n<h4>Life &amp; Disability<\/h4>\n<p>VBA\u2019s Life &amp; Disability module provides for easy administration of Short-Term Disability, Long-Term Disability, AD&amp;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.<\/p>\n<h4>FSA - HRA - HSA<\/h4>\n<p>VBA\u2019s 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.<\/p>\n<h4>PBM Administration<\/h4>\n<p>VBA\u2019s 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.<\/p>\n<h4>Reinsurance<\/h4>\n<p>VBA\u2019s 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 \u2013 contract length, lasers, coverage exclusions based on benefit and procedure codes \u2013 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.<\/p>\n<h4>Premium Billing<\/h4>\n<p>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.<\/p>\n<h4>Commissions<\/h4>\n<p>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.<\/p>\n<h4>.... AND MORE<\/h4>\n<p>We offer updated technology, including a Gateway for stress-free enrollments.<\/p>\n<p>We also offer Bennie cards, for your Flex spending needs. The advantages of the Bennie card are:<br \/>\n~ 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.<br \/>\n~Some debit card transactions may require receipt verification<\/p>\n                <\/div>\r\n                                <div post_id=\"1008\" itemcount=\"1\" header_id=\"header-1626158509684\" id=\"header-1626158509684\" style=\"\" class=\"accordions-head head1626158509684  tab\" toggle-text=\"\" main-text=\"Wellness Programs\">\r\n                                            <span id=\"header-text-1626158509684\" class=\"accordions-head-title\">Wellness Programs<\/span>\r\n                        <span id=\"accordion-icons-1626158509684\" class=\"accordion-icons\">\r\n                            <span class=\"accordion-icon-active accordion-plus\"><i class=\"fas fa-chevron-up\"><\/i><\/span>\r\n                            <span class=\"accordion-icon-inactive accordion-minus\"><i class=\"fas fa-chevron-right\"><\/i><\/span>\r\n                        <\/span>\r\n                                        <\/div>\r\n                <div class=\"accordion-content content1626158509684 \">\r\n                    <p>There are numerous benefits of worksite wellness programs. In fact there are more than 200 scientific studies indicating the positive return-on-investment for worksite wellness programs.<\/p>\n<p>That said, this listing is not extensive, but will note some of the widely accepted benefits of worksite wellness programs.<\/p>\n<p>Worksites are crucial to improving the health of their workers. Most adults spend more of their waking hours at work than anywhere else, making it a prime venue for promoting healthful habits.<\/p>\n<p>Many employers use the wellness programs to promote and support the health, safety, and well-being of its employees.<\/p>\n                <\/div>\r\n                    <\/div>\r\n    <script>\r\n        jQuery(document).ready(function($){accordions_active_index_1008 = [];        })\r\n    <\/script>    <script>\r\n        jQuery(document).ready(function($){\r\n            accordion_1008  = $(\"#accordions-1008 .items\").accordion({\r\n                event: \"click\",\r\n                collapsible:true,\r\n                heightStyle: \"content\",\r\n                animate: (\"swing\", 1000),\r\n                navigation: true,\r\n                active: 999,\r\n                                beforeActivate: function(event, ui) {\r\n                    if (ui.newHeader[0]) {\r\n                        var currHeader  = ui.newHeader;\r\n                        var currContent = currHeader.next(\".ui-accordion-content\");\r\n                    } else {\r\n                        var currHeader  = ui.oldHeader;\r\n                        var currContent = currHeader.next(\".ui-accordion-content\");\r\n                    }\r\n                    var isPanelSelected = currHeader.attr(\"aria-selected\") == \"true\";\r\n                    currHeader.toggleClass(\"ui-corner-all\",isPanelSelected).toggleClass(\"accordion-header-active ui-state-active ui-corner-top\",!isPanelSelected).attr(\"aria-selected\",((!isPanelSelected).toString()));\r\n                    currHeader.children(\".ui-icon\").toggleClass(\"ui-icon-triangle-1-e\",isPanelSelected).toggleClass(\"ui-icon-triangle-1-s\",!isPanelSelected);\r\n                    currContent.toggleClass(\"accordion-content-active\",!isPanelSelected)\r\n                    if (isPanelSelected) { currContent.slideUp(); }  else { currContent.slideDown(); }\r\n                    return false;\r\n                },\r\n                            });\r\n        })\r\n    <\/script>\r\n                <\/div>[\/et_pb_text][et_pb_text module_class=&#8221;orange_color&#8221; _builder_version=&#8221;4.5.3&#8243; _module_preset=&#8221;default&#8221; header_2_font=&#8221;Open Sans|600||on|||||&#8221; header_2_text_color=&#8221;#0e76bc&#8221; header_2_font_size=&#8221;28px&#8221;]<a href=\"https:\/\/www.wltmediportal.com\/MediClm\/\" target=\"_blank\" rel=\"noopener\">MediPortal<\/a>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Why Use A TPA Employers Members Providers Producers 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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":703,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-1006","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/pages\/1006","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/comments?post=1006"}],"version-history":[{"count":12,"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/pages\/1006\/revisions"}],"predecessor-version":[{"id":2080,"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/pages\/1006\/revisions\/2080"}],"up":[{"embeddable":true,"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/pages\/703"}],"wp:attachment":[{"href":"https:\/\/ighcp.com\/ebs\/wp-json\/wp\/v2\/media?parent=1006"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}