Third-Party Administrators

Third-Party Administrators (TPAs) are organizations that process billing, claims, or credentials on behalf of payers and providers. They often rely on high volumes of transactions to achieve growth and profitability.

This requires a set of processes and technology that maintain a “source of truth” for provider, payer, and facility relationships so that claims are evaluated and paid correctly.  It can also be improved through contract automation that eliminates the need for mailed and faxed contracts. Fourleaf’s support for TPAs users includes a user experience focused on managing these payer and provider relationships.

Expected TPA Outcomes

Due to a high volume of transactions, TPAs experience challenges in increasing process efficiency and evaluating new processes and technology updates.  TPAs that don’t implement efficient focused process and technology updates may face unnecessary competitive cost pressure (e.g., resource-intensive processes).  

70% of physicians agree that SDOH factors should be evaluated by insurance companies*

73% of physicians agree that SDOH factors contribute to healthcare costs*

Does your TPA have the data?

  • Reduce credential error resulting in denied claims
  • Reduce contact and location errors within published directories
  • Improve process to design, build, and manage networks and providers
  • Reduced costs in system design and clearinghouse/external integrations
  • Reduce contact and location errors
  • Reduce paperwork and payor information requests
  • Improve processing of network builds and provider recruitment resulting resulting in higher TPA customer satisfaction
  • Determine provider and speciality coverage areas
  • Adapting to new telemedicine requirements
  • Overlay SDOH factors with network design
  • SDOH – Increase network accessibility decrease SDOH impact
  • Network adequqcy
  • Accurate and current credential details
  • Directory publication
  • Data security and oversight
  • Data Sharing

Request a Demo