Evaluating Your Third-Party Administrator: Are You Getting What You're Paying For?

Are you monitoring your third-party administrator to ensure they are giving you what you are paying for?

Many employers - both private and municipal - offer benefit programs to their employees; focusing on maximizing the benefit offerings while minimizing the associated costs. To aid them in structuring and administering these programs, they secure the services of a third party administrator.

Such third party administrators or ‘TPA's' strive to deliver administrative services in accordance with their service agreements, but also make efforts to avoid taking on a fiduciary role or offer guidance beyond that which they are contractually obligated to provide. Some fall short of even this benchmark, failing to deliver and exposing their clients (and themselves) to legal liability, whilst others go above and beyond - creating exceptional value for their clients.

This information will enable any and all entities responsible for identifying, selecting, and monitoring their TPA to track performance and assess results, as well as identify opportunities to create additional value in collaboration with their TPA. The material will explain how to avoid regulatory and other pitfalls, while ensuring every aspect of a successful benefit plan is being handled.

Agenda

Introductions

• Speakers
  
• Industry Involvement

Third Party Administrators

• Industries (Where Are TPAs Used?)
  
• Dynamic
  
  • Affiliation
    
  • Network
    
  • Claims Process
    
  • InHouse vs. Subcontractors
    
• Industry Trends (Growth and Characteristics)

TPA Benefits

• Scenarios Where the TPA Added Value
  
• Data
  
  • Types
    
  • Uses
    
• Customization – the Good

TPA Pitfalls

• Recent Cases Involving Conflicts and Mistakes
  
• Issues for Which There Is No Recourse
  
  • Alignment vs. Conflict With StopLoss
    
• Customization – the Bad

TPA Assessment and Monitoring

• Reviewing the ASA
  
  • What to Look for
    
  • Right to Audit
    
• Reports
  
  • Type of Info TPAs Should Share

TPA Communication

• What a TPA Does
  
• What a TPA Does Not Do
  
• What the Client Needs to Communicate

Other Entities Involved

• Insurance
  
• Vendors
  
• Brokers
  
• Employer
  
• Employees

• CLE
• CPE
• SHRM
• NASBA

• HR Certification Institute

For Detailed Credit Information page click here

Only registered attendee will receive continuing education credit.

Ron E. Peck, Esq., The Phia Group, LLC

• Senior vice president and General Counsel and has been a member of The Phia Group, LLC’s team since 2006
• As an ERISA attorney with The Phia Group, he has been an innovative force in the drafting of improved benefit plan provisions, handled complex subrogation and third party recovery disputes, health care direct contracting and spearheaded efforts to combat the steadily increasing costs of health care
• Considered to be not only one of the nation’s top ERISA lawyers, he is also viewed as one of the nation’s premier self-funded health plan consultants and health benefits attorney; lecturing at and participating in many industry gatherings including but not limited to The National Association Of Subrogation Professionals (NASP) Litigation Skills Conference, Society of Professional Benefit Administrators (SPBA), the Health Care Administrator’s Association (HCAA), The Health Plan Alliance, and SIIA
• Curently serves as The Phia Group’s senior vice president and General Counsel, and is also a dedicated member of SIIA’s Government Relations Committee
• J.D. degree, Rutgers University School of Law; B.S. degree in policy analysis and management, Cornell University

Adam V. Russo, Esq., The Phia Group, LLC

• CEO and founding principal – The Phia Group, LLC
• Founding partner – The Law Offices of Russo & Minchoff
• Provides cost containment services to health benefit plans and all entities servicing them
• Conducts regular seminars and workshops on numerous cost containment topics including subrogation, medical bill negotiation, benefit plan formation, ERISA, the ACA, and regulatory compliance
• Written several publications related to the areas of health plan administration, best practices and cost containment
• J.D. degree, Suffolk University Law School; master’s degree in finance, Frank Sawyer School of Management at Suffolk University in Boston; undergraduate degree in political science and public relations, Suffolk University