How a Healthcare Technology Partner Can Enhance Operational Efficiency for Third-Party Administrator
Across other industries, digital transformation has been ongoing for decades, leading to increased efficiencies. In healthcare, modernization has occurred rapidly on the clinical side, but the financial aspect of the industry—the billing, claims management, payments, and communications—has not evolved at the same pace. The result is administrative burdens, outdated processes, and complicated technology stacks that slow down care.
As the critical conduit between employers and insurers, third-party administrators (TPAs) experience first-hand the complexities and inefficiencies of managing and facilitating the healthcare financial experience. With a keen focus on member satisfaction, TPAs understand that the healthcare financial experience can be just as important to how consumers engage with, feel about, and respond to healthcare.
Is it possible for TPAs to modernize manual processes like claims management and simplify compliance in a way that enables care to flow with less burden? The answer lies in collaborating with a healthcare technology partner that offers scalable, integrated solutions designed to meet the ever-changing needs of TPAs.
Technology creates greater efficiency for claims management
The introduction of the No Surprises Act (NSA) in 2022 added new layers of complexity for TPAs to manage on behalf of their clients. The regulation intends to protect healthcare consumers from surprise medical bills but managing the volume of billing inquiries while maintaining compliance has added administrative challenges for TPAs.
According to Bryan Russo, Senior Vice President of Sales at Zelis, TPAs bear the responsibility of managing all the complexities that surround claims management – inquiries, appeals, billing disputes and ensuring accuracy.
Claims management is often associated with administrative inefficiencies, numerous point solutions, and a lack of integration. This introduces errors that make it harder for TPAs to resolve claims-related issues quickly and accurately.
Improving the accuracy and efficiency of claims management is feasible. A purpose-built technology solution can analyze data gathered from claims management to identify patterns and potential errors. By leveraging the data, TPAs can deliver better outcomes for their clients that result in more informed patient care.
The right technology partner unlocks efficiency and better care outcomes
Supported by the right partner, TPAs can more efficiently manage claims and reduce healthcare costs related to administrative tasks while minimizing the potential burden on providers and healthcare consumers.
“[At Zelis], we built integrations within every core adjudication platform. What that means to the TPA is that implementation is not two years. It’s 60 to 90 days,” Russo says. That level of scale and industry expertise improves operational effectiveness for TPAs that seek to effectively analyze claims data, prevent errors, and identify irregularities.”
What’s more, it streamlines claims management for TPAs. Russo adds that a “big benefit of having an integrated solution” is that TPAs can reduce operational inefficiency, potential errors, and manual processes. Combining state-of-the-art technology and clinical billing expertise enables TPAs to deliver greater value for their clients, increasing long-term satisfaction.
A technology partner that understands the unique complexities of the healthcare financial system can help care flow and also help TPAs to comply with the ever-evolving regulatory landscape. Through advanced analytics, TPAs can more proactively manage compliance by identifying claims data patterns while ensuring compliance and mitigating risk.
Achieving streamlined operations with a unified technology solution
Modernizing the maze of financial systems and processes is crucial for removing the unnecessary friction and outsized administrative burden that many TPAs face today.
Russo adds that by eliminating point solutions and offering a unified, enterprise-grade solution, TPAs can increase their value to clients because they’re offering more seamless and effective solutions for members. The modernization of the healthcare financial experience is already underway and TPAs are experiencing improvements that have meaningful impact on their clients.
Finding the right technology partner is the foundational first step. There are several questions TPAs should interrogate with potential partners to ensure core competencies address the needs of the business today and in the future.
- Is the technology built specifically for the healthcare market, or is the solution adapted from an adjacent industry?
- How is the technology unlocking operational efficiency for other TPAs?
- Can the technology be adapted or customized to address unique needs?
- Is the technology built to comply with the demands of federal and state regulations?
Conclusion
In an increasingly competitive market, TPAs differentiate when they deliver advanced technological capabilities, breadth of services, and a member-centric approach. This results in improved trust in the healthcare financial experience, higher levels of satisfaction, and a greater willingness from members to engage in care.
Engaging a healthcare technology partner offers TPAs invaluable support in navigating the complexities of claims management and compliance. A strong technology partnership not only enhances efficiency but improves accuracy and fosters stronger relationships with employer groups. Ultimately, a strategic partnership with the right technology partner empowers TPAs to deliver better outcomes for both clients and members, positioning them competitively in the evolving healthcare landscape.
