TPA's offer valuable services. The problems I see in workers' compensation cost control programs is usually not because the TPA does not provide good services, it is because the employer does not understand the services, does not ask for the services or does not integrate the services into their existing program well.
One way to correct these problems is to review their literature closely. Among the first things I recommend when working with a company is to find out who is handling the claims and find out all the auxiliary vendors being used. An auxiliary vendor is usually owned by or affiliated with the claims administrator.
Integration is key to having a smooth claims handling operation and its difficult to integrate your TPAs programs until you know those programs thoroughly. Here are five ways to find out more about your vendors and services.
1- Read the literature.
2- Visit each vendor and ask questions endlessly. Ask the vendor to visit your operations and offer suggestions for integration.
3- Underline and highlight important features in the literature. This may sound basic, but its fundamental that you understand both the general concepts of each service and the details of how each works for YOU.
4- Read your Account Handling Instructions and include each service in your SHIs. For example, if you want Nurse Case Management (NCM) to come in on ALL lost time claims when the employee does not obtain medical restrictions during the first office visit, it's important to know when NCM normally joins the team. If NCM normally works each lost time claim upon reporting, then you'll need to have them come in later; if they do not normally work lost time claims, but only work catastrophic claims, you need to bring them in earlier.
5- Place these special instructions in the SHIs so the adjusters around the country know this is what to do for YOUR account.
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