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Third Party Administrator (TPA) Reviews  Follow our Service Listing on LinkedIn!

It is crucial for employers to have a complete understanding of the capabilities and competencies of the third party administrator (TPA), or self-administering claim department, which processes the employer's self-funded benefit plan. To that end, we work directly with employers, and closely with brokers/consultants and their employer clients, to formulate a scope of audit that meets due diligence and budgetary requirements.

Our audits of TPAs and self-administered claim departments can include any or all of the following components:

  • Simple and stratified random sample claim audits
  • Focused issue claim audits, such as large claims
  • Targeted issue claim audits, such as subrogation or overpayment recoveries
  • Operational best practice and protocol overviews
  • Electronic eligibility data audits
  • Electronic duplicate claims audits
  • Review of stop loss specific and aggregate claim reimbursements
  • Other client specific needs and concerns

Stephen V. Murphy Follow me on LinkedIn
Danvers, MA 01923
978.745.6655
smurphy@niis.com



Accident & Health
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