Workers Compensation 10 Tips for Selecting a Third Party Administrator

Selecting a quality third-party administrator (TPA) is critical to keeping your claims costs down. Here are 10 useful tips to consider when making your selection. 1. Internal Audit Procedures – how does the TPA ensure internal quality control and correct any problems when they arise? Do they have a proactive internal audit program where all offices must meet high quality standards? Are files from every adjuster audited? 2. What are the Best Practices – do they achieve > 80% of their best practices. Ask to see the how the offices and adjusters are scored. 3. Do they provide administrative assistance for adjusters for tasks such as obtaining medical records, paying bills, setting up files, filing all forms, preparing for claims reviews, getting “one-step” prints, etc. This frees time for the adjusters to handle more complex responsibilities. 4. Will they provide dedicated adjusters — so you can have the same adjuster/s handling all of your claims? 5. Are senior adjusters handling catastrophic claims and fatalities? 6. Do they have established relationships with investigators nationwide which can be used in all locations? 7. Do they encourage quarterly onsite claim reviews and/or regular (perhaps weekly at the client’s discretion) telephone “roundtables? 8. Do the Plans of Action (POAs) included specific action steps — not just “get employee back to work.” 9. Do adjusters have “e-triage” questionnaires (that can be customized) for the uniform development of information during Three-Point Contact and identification of problematic claim issues? 10. Is medical management well-integrated and available? Does medical management include Sr. Nurse Reviewers and MDs for peer-to-peer on a claim-by-claim basis when needed? Author: Rebecca Shafer, J.D. Rebecca designs and develops workers’ compensation cost containment programs, and is the developer or Workers’ Comp Kit, an on-line automated tool kit with an assessment, benchmarking and improvement plan. Rebecca can be contacted at: 860-786-8286 and email: [email protected]. http://www.ReduceYourWorkersComp.com