Changing TPAs:
What to Consider
Speakers:
Paulette Harris-Rogers, Sr. Director Risk Management
HD Supply
Sharon LaCour, Account Principal
Gallagher Bassett Services
Atlanta RIMS Educational Conference
Feb. 9, 2017
Learning Objectives
At the end of this session, you will:
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Build a Comprehensive Timeline
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Be Familiar with Carrier Considerations
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Manage Legacy/New TPA; Carrier & Internal Action Items
Sign-off; Fees; Specific Requirements
Be Better Prepared for Go-Live Date & After
Atlanta RIMS Educational Conference
2/9/2017
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Agenda Topics
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The RFP Process
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Factors: Client & TPA
How Many? How to Combine?
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Hidden Fees; New & Ongoing Costs
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Run-in Claims; Posting Notices;
Physician Panels;
When You Think It Is All Done
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Atlanta RIMS Educational Conference
Implementation Plan; Mapping;
RMIS; OSHA; Payroll
Let’s Get Started
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Budget Considerations
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Before You Start
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Transition Timeline
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Program Management; Adjuster
Changes on Legacy Programs;
2/9/2017
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The RFP Process: Client
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Carrier/Broker Referrals
Sourcing Dept./Broker Resources
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List of Approved TPAs
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Brokers Claims Consultant Insight
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Consider Company Size;
Geographical Footprint
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Bundled v. Unbundled
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Industry Events – demos; peers
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RFP Content
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Current TPA
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Check Termination Language
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Incumbent Participation
Atlanta RIMS Educational Conference
Help Narrow Scope & Decision for
RFP
Interface w/ prospective vendors
Sample RFP Language
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Case Scenarios
RFP Response Review
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Interview/Review Team BIOs
2/9/2017
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The RFP Process: TPA
Atlanta RIMS Educational Conference
2/9/2017
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Transition Timeline: Basic
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Main Decision
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TPA Change During Policy Renewal or Off-Cycle?
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Consider the Size of the Program (Claim Frequency & Transaction Count)
Draft Timeline
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Legacy TPA Term Notice in Accordance with Contract (60-Days)
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New TPA Requires a Minimum 90-day Transition Period
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Broker to Notice Carrier
Atlanta RIMS Educational Conference
2/9/2017
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Transition Timeline: Practical
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Legacy & New TPA
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Minimum 90-Days
Carrier Timeline
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System Mapping/Testing
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State Notices
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Collateral
Internal Timeline
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Actual Timeline
30 Day
60 Day
90 Day
180 Day
Legacy TPA
Carrier
New TPA
Payroll/Data Setup
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Mapping
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Notification
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Training
Atlanta RIMS Educational Conference
Internal
2/9/2017
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Budget Considerations
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Legacy TPA
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Data Access
Continued Account Management
Escrow
New TPA
Escrow for Claim Payments; TPA Fee; Fee for Run-in Claims
• Claim Funding (How Often)
• Monitor Indemnity Payments
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Carrier
Charge for the TPA Change
• Change to Loss Pick (Broker Assistance)
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Financial Considerations v Fiscal Budget
Atlanta RIMS Educational Conference
2/9/2017
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Before You Start : TPA Implementation
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Program Set-Up
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Dedicated Implementation Team
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Implementation timeline and meetings to better understand your
operations
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Making a change is difficult, work with a TPA that has the experience to lead the
project through each step while communicating openly and regularly, as the
change is executed.
Custom data capture
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Expertise and Experience
Monitors and Measures
Development of your specific account structure and claim instructions
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5 W’s – Who, what, where, why and when
Atlanta RIMS Educational Conference
2/9/2017
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Before You Start
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Moving Legacy Data to the New TPA
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RMIS System
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Follow New TPA’s Lead in the Mapping
Process
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Additional Data You Want the New TPA
to Capture
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Correct Errors/Gaps in Information
Prior to Moving Data
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Consider Affect to OSHA
Recordkeeping & RMIS System
Atlanta RIMS Educational Conference
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Payroll/ Location Updates from
Internal Team to the New TPA
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How Often to Update?
State Statutes & International
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Monopolistic States – State Fund vs
Self-Insured
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Special State Requirements (CA, TX)
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USA Territories
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International Capabilities
2/9/2017
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Let’s Get Started
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Internal Change Notice
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Current Associates on Work Comp
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Notifying Internal Managers
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Notification of the Change
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Internal Documents and Contacts
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Intranet Pages
Keep the Claim Moving
(Coversheets/Indemnity Payments)
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Adjuster Contact Information
Locations in the Field
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Posting Notices Changed to Reflect
New TPA Contact Information
Physician Panels – Changes for New
TPA Network
Atlanta RIMS Educational Conference
Benefits
• Medical Treatment
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Internal Transition Team
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Provide insight on how to
communicate change within field
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Alleviate the “From the Top”
perception
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When You Think It Is All Done: TPA
• Program Management
Program Management
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Risk Management Information System: User friendly with KEY information
available.
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Development of reports and automated scheduling
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Weekly / Monthly open items call schedule – team performance/program
changes/staff changes
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Details matter: Claim review schedule
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Annual stewardship meeting to reflect progress and suggest enhancements
Atlanta RIMS Educational Conference
2/9/2017
12
When You Think It Is All Done
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Adjuster Changes on Legacy Casualty Program
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Claims Still Being Reported to Legacy TPA
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New Claims with Prior DOL’s
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Providers Sending Invoices to Legacy TPA
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Adjust to Change
• New Software
• New Program Manager
• New Adjusters/Training
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Client Handling Instructions
Program Management
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Telephonic Claim Review
Claim Audit
Atlanta RIMS Educational Conference
2/9/2017
13
Q&A
When you come to the end of your rope, tie a knot and hang on.
- FDR
Atlanta RIMS Educational Conference
2/9/2017
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