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Changing TPAs: What to Consider CLM004
Speakers: Paulette H. Rogers, Sr. Director Risk Management, HD Supply
Linda Hoenshel, CPCU, Sr. Claims Manager, HD Supply
Learning Objectives
At the end of this session, you will: • Build a Comprehensive Timeline
– Manage Legacy/New TPA; Carrier & Internal Action Items
• Be Familiar with Carrier Considerations – Sign-off; Fees; Specific Requirements
• Be Better Prepared for Go-Live Date & After
Agenda Topics
• Discussion Baseline – RFP Selection Complete; Working on Transition Plan
• Transition Timeline – How Many? How to Combine?
• Budget Considerations – Hidden Fees; New & Ongoing Costs
• Before You Start – Location Mapping; RMIS Systems; OSHA Recordkeeping; Payroll Feed
• Let’s Get Started – Run-in Claims: Coversheets; Indemnity Payments – New TPA: Posting Notices; Physician Panels; International Locations
• When You Think It Is All Done – Adjuster Changes on Legacy Programs; Provider Invoicing Errors
Discussion Baseline
• RFP Process Complete – New TPA Selected – New TPA Fee Determined – New TPA Already Approved by Carrier
• Deductible Program – Some Carrier Involvement: High/Low Deductible or Retention
• Legacy TPA Termination – Typical Contractual 60-Day Notice of Termination Language
Transition Timeline
• Main Decision – TPA Change During Policy Renewal or Off-Cycle? – Consider the Size of the Program (Claim Frequency & Transaction Count)
• Draft Timeline – Legacy TPA Term Notice in Accordance with Contract (60-Days) – New TPA Requires a Minimum 90-day Transition Period – Broker to Notice Carrier
Basic Timeline 30-Day 60-Day 90-Day Go-Live
Legacy TPA Term New TPA
Transition Timeline
• Legacy & New TPA – Minimum 90-Days
• Carrier Timeline – System Mapping/Testing – State Notices – Collateral
• Internal Timeline – Payroll/Data Setup – Mapping – Notification – Training
Actual Timeline 30 Day 60 Day 90 Day
180 Day
Legacy TPA
Carrier
New TPA
Internal
Budget Considerations • Legacy TPA
– 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
• Carrier – Charge for the TPA Change – Change to Loss Pick (Broker Assistance)
• Financial Considerations v Fiscal Budget
Before You Start
• Moving Legacy Data to the New TPA – RMIS System – Follow New TPA’s Lead in the Mapping Process – Additional Data You Want the New TPA to Capture – Correct Errors/Gaps in Information Prior to Moving Data – Consider Affect to OSHA Recordkeeping & RMIS System
• Payroll/ Location Updates from Internal Team to the New TPA – How Often to Update?
• State Statutes – Monopolistic States – State Fund vs Self-Insured – Special State Requirements (CA, TX) – USA Territories
Let’s Get Started
• Internal Change Notice – Notifying Internal Managers – Internal Documents and Contacts – Intranet Pages – Adjuster Contact Information
• Locations in the Field – Posting Notices Changed to Reflect New TPA Contact Information – Physician Panels – Changes for New TPA Network
• Current Associates on Work Comp – Notification of the Change – Keep the Claim Moving (Coversheets/Indemnity Payments)
• Benefits • Medical Treatment
When You Think It Is All Done
• Adjuster Changes on Legacy Casualty Program • Claims Still Being Reported to Legacy TPA • New Claims with Prior DOL’s • Providers Sending Invoices to Legacy TPA • Adjust to Change
– New Software – New Program Manager – New Adjusters/Training
• Client Handling Instructions – Telephonic Claim Review – Claim Audit