A Third-Party Administrator (TPA) is an organization that processes insurance claims that are admissible under health insurance. When a health insurance claim occurs, the TPA almost acts as an intermediary between the insurer and the insured. The key process involves claims processing and settlement. In fact, they are the link between the policyholder and the insurer with a claim being made.
➡ A Third-Party Administrator (TPA) is chosen by a health insurance firm to facilitate all reimbursement-related exchanges between the provider and the patient. There is a lot of work that is done indoors and on time to maintain this equilibrium. Working with an experienced and knowledgeable specialist who fully understands the intricacies of TPA billing can help streamline the insurance claim process and lead to an improved outcome.
➡ Finding a genuine vendor who can deliver quality support consistently is a matter of very important concern. TPAs generally keep very busy, having to handle claims and associated matters in high volumes. Labor shortage and rising cost continue to make their operations increasingly difficult. In view of this, outsourcing billing and other administrative tasks is a convenient and economical option.
➡ As healthcare services continue to proliferate and patient volumes keep soaring, managing operations efficiently without letting expenses go out of hand is a major concern. Not all RCM companies will be able to drive your reimbursements in the way you desire. Only the right partner can make things possible for you in the best proportions.
It all boils down to appointing someone who knows how to work on your Third Party Administrator (TPA) billing right from start to finish with consistency and trust. Finding a top class TPA billing service provider can actually be the answer you seek.
Services for Third-Party Administrators
At Sunknowledge, we provide a wide range of services that make managing any TPA business so much easier. Our services are tailored to address challenges most commonly faced. Our top-line services include comprehensive assistance in:
- Demographic Entry
- Eligibility Verification
- Prior Authorization
- Coding (ICD-10, CPT, HCPCS, DRG)
- Claim Management
- Accounts Receivable & Denial Management
- Payment/Check Posting
- Virtual Office Assistance
Besides these, we also provide a host of value-added services such as:
- Database & Data Management
- Data in-load, validation & sanitization
- Formatting eligibility files using SQL queries
- Generating reports for provider credentialing
- Communication & Documentation
- Q-Auth letter generation for members and providers
- Q-Auth software quality assurance
- Benefit & Plan Management
- Setting up claims adjudication systems by defining copay, benefit limits and other plan-specific configurations
- Provider Verification
- Verifying provider details through communication and follow-ups
- Analyzing provider contracts and summarizing rate agreements
- Patient Care & Management
- Perform health risk assessments, patient outreach, care plan setup, post-hospital discharge mgmt.
- Coordinating inpatient services like scheduling follow-ups and uploading medical records
- Customer & Claim Support
- Handling patient inquiries related to appointments, claims, authorizations, and referrals
- Addressing claims inquiries from members, providers, and hospitals, guiding resubmissions, and updating member records
The Sunknowledge Approach
Over the last decade and more, we have been serving reputed TPAs and healthcare payors with great success and consistency. Some of the best names in the business work with us. Right from leading TPAs to top-class providers, our ability to work on patient claims with high speed and accuracy makes us a true powerhouse in the world of Third Party Administrator (TPA) billing.
Hire us if you want to focus on creating a better experience for patients and providers alike. Our team of expert billers and coders is well versed with the latest claims adjudication mandates and can expertly eliminate proven flaws both in your front and back-end efforts.
Remember, only Sunknowledge gives you the assurance of:
- 99% overall accuracy
- Up to 80% reduction in current cost
- Real-time support across all time zones
- No binding contracts; no restrictive clauses; clear, transparent pricing
- Highly scalable FTE-model based resource allocation
- Dedicated Team Leaders and Account Managers at no extra cost
- All services available at $7/hour per FTE
Looking for more information on how we work on Third Party Administrator (TPA) billing?
We are just a call away from you. Our robust presence, versatility, and competence across multiple billing software systems, along with our understanding of timely filing limits and deadlines make us a genuine healthcare services company.
Talk to a Sunknowledge expert now!