Vendor Day is a concept I invented 10 years ago because I saw numerous instances of when companies did not know the services their TPA’s offered. For example, a client was unhappy with their TPA because they felt the nurse case management was too expensive, yet they had not been to the claims offices to see how integrated and valuable the nurse case management services were.
It is important to know the full array of your TPA services, how they charge for those services and see samples of the “deliverables” (the products). I use the terms TPA and claims administrator interchangeably. If you need more information about these two services go to WC 101.
Have your TPA explain each and every service they offer.
- Show you and example of the service. If it’s a medical bill audit, have them show you an example of how those bills are audited and what documentation you will recieve. Or, tour the medical bill audit dept. for a much better understanding of the process.
- Find out the different options for payment. E.G. by percentage of savings or per line.
For example, these are some of the services TPAs have:
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Employee Communication Brochures (English & Spanish)
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Medical Bill ReviewHospital Bill Review
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Pharmacy Bill Review
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Field-based Nurse Case Managers
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Physician Consultants/Advisors
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Peer Review
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Durable Medical Goods such as wheelchairs, crutches and TENS units
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Return to Work Services
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Work Hardening Centers
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Catastrophic Case Managers
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Transportation Services
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Translation Services
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Investigators
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Legal Services
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Structured Settlement Firms — for MSAs and Settlements
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Loss Control Services
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Training Tapes and Video Library
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Risk Management Information Systems
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Subrogation & Recovery Services
In order to ASK for something, you must know it exists. For example, one client with multiple locations had a poor reporting rate — only a few of their claims were being reported timely. But it had been several years since the carrier had sent new reporting kits so we had the carrier do another “national roll-out.” The client couldn’t possibly ask for a “national roll-out” if they don’t know that exists, can they?
AIG does a super job at national rollouts. They have “PICs” (pre-injury coordinators) — cost containment experts that visit each facility and explain the fundamentals of cost containment, return to work programs, etc. However, if you don’t know what the PIC program is, you can’t possibly ask for the service.
If you would like a Sample Agenda for a Vendor Day. Send me an email to [email protected] and I’ll be happy to send you one the next day!
For more ideas on how to integrate services with your TPA, click here: Cost Containment Ideas
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact I[email protected]
