6 Things You Can Review To Determine Whether Your Claims Administrator is Doing a Good Job?

What items must you review to determine whether your TPA is doing a good job? What tools should you have to determine whether your TPA is doing a good job? Here are 5 items (there are others, but these are the 5 we are reviewing today) you can review to start in your internal audit of whether your claims administrator is doing a good job FOR YOU. 6 things you can review to determine how well your TPA is doing: 1- Best Practices – ask for a copy of their best practices and see what they say they will do to handle your claims. 2- Product/Service Literature – have a CLOSE look at their literature, bring your yellow highlighter and STUDY what level of service has been promised via the sales literature. It helps you understand what is available. 3- Account Instructions– Make sure you review your SHI's (special handling instructions) so you know what is being done, what vendors are being used and who has authority for which activities. If you don't know what these are go to: Account Instructions 16 Key Points 4- Files (including medical records) – Have an MD and a claims expert as a team independently review a few of your files to SEE how well they are being handled. 5- Office Visits & Sitting "Chair-side" – Visit the claims office, or several offices to SEE what the adjusters are doing on your behalf. Many companies visit EVERY claims office EVERY year. Yes, really! 6- Loss Runs – How many employees are STILL out of work (OOW)? How many are not back to work or on transitional duty? Why not? If it's a high percentage you need to analyze the reason for so many employees being OOW. Frankly, it doesn't make a big difference if they are the best TPA in the world, if they aren't doing a good job for YOU, you need to take action. BUT, before you start ranting at the adjusters and supervisors at your TPA you'll need to review your own participation in the process. I have seen many situations where a company blames the TPA for things that are not within their control, and are elements of a cost containment program YOU — THE EMPLOYER — should be doing better. So, look at TPA performance as well as your own role in the process. For more cost savings tips go to WC Cost Reduction Tips. Show the REAL cost of workers comp with the Real Cost Calculator. Workers' Comp Kit® is a best practice approach to workers' compensation cost containment. It includes assessment, benchmarking and an improvement plan. 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]