Third-Party Administrator: How does TPA digitalize health operations in Insurance?

| 3 minutes read

Third-Party Administrators support insurance corporations with reimbursement processes and claims management. Their job is usually under the radar but has significant value in the value chain of insurance processes. Insurance companies often decide to outsource most of the technical activities related to claims processing: this is where TPAs come in.

What is a Third-Party Administrator

A Third-Party Administrator is a company that provides operational services such as claims processing and employee benefits management. Insurance companies often outsource their claims processing to third parties. These companies are often referred to as third-party claims administrators. 

TPAs can be of different types depending on their business model. They can be autonomous and independent companies, owned by insurance corporations, or managed even by hospitals. They work to align all the requests coming from consumers with the insurance’s offering packages, encompassing the variety of partners involved in the healthcare providers industry as hospitals, care facilities, and assistance providers. 

The Role of TPA in the insurance sector

Third-Party Administrators link customers and insurance companies, and employees with employers, with many partners providing care, wellness, and well-being services. Bringing all this complexity together may seem like a daunting challenge, but this is the space in which insurance TPAs operate.

Healthcare systems worldwide are notoriously expensive, fragmented, and often slow in handling claims and reimbursements. TPAs were born to simplify this complex system by helping companies enhance the quality and depth of health plans offered and employees improve access to care offerings based on their health needs.

How TPA supports insurance companies in health operations

There has been a steep increase in the number of solutions offered by the healthcare industry thanks to cloud-native technology and digitalization. While this explosion of new digital tools led to more innovation, it increased the market complexity in terms of operational excellence. TPA can support insurance companies to make health offerings and care plans more coordinated, connected, and seamless, enabling a user journey that is custom, flexible, secure, and simple to follow to access healthcare services provided by insurance or employer.

In the health insurance industry, TPAs also provide administrative services for self-funded health plans, sometimes referred to as self-insured health plans. A TPA can also simplify access to various healthcare networks and may be able to source additional vendors, such as stop-loss insurers.

How Mia-Care enables the creation of microservice-based TPA Portals

Mia-Care can leverage Mia-Platform IDP to conceive a TPA Console Builder aimed to improve operations efficiency – namely, decrease the average time of claims management and number of claims managed manually – and provide a flawless user journey for final users and administrators thanks to a user-friendly portal that speed up the claims management and reimbursements processes.

With Mia-Platform’s cutting-edge technology, TPA can build a composable architecture that adapts to a wide spectrum of bespoke needs from insurance, final users, and care partners. Moreover, by leveraging Fast Data technology, it will be easy to manage claims requests faster thanks to a message broker already embedded in the IDP, and it is easy to configure based on TPA’s operational needs. Finally, the creation of a microservice-based middleware enhances technical efficiency in the governance of communications among factories that will improve consistently, thanks to a performant API gateway.

Mia-Care enables you to build your own TPA Console Builder with the following features:

  1. creation of reusable bespoke services thanks to a Composable approach;
  2.  easy and fast integration of microservices and API with core insurance applications;
  3.  integration middleware with healthcare facilities via API;
  4.  document recognition and automated management by design via technology partners;
  5.  configurable white label portals provided to the healthcare facility and welfare providers’ network;
  6.  configurable portals for internal management of the healthcare facility network;
  7.  provision of additional services (virtual primary care, digital pharmacy) by design.

A reliable example of TPA digital transformation supported by Mia-Care

Mia-Care supported Previdigital, an Italian TPA, to modernize its core service for TPA operations by developing a new cloud-native modular architecture to help IT factories streamline the management of all the claims processes. In addition, thanks to Mia-Care’s cutting-edge technology, Previdigital launched RBdigital, the first digital platform for managing digital claims and reimbursement from care services dedicated to the B2B and B2C market, enhancing interoperability between systems and improving access to the network of facilities for patients.

Discover more about the use case. Read the full success story here.

The article was written by Andrea Di Carlo, .

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