To truly have a successful claims administration program, organizations need to actively collaborate with their Third-Party Administrators (TPAs) and view the relationship as a strategic partnership. Like all good relationships, this one needs to be based on trust and well-understood expectations.

Companies that recently have or are about to switch TPAs are in a great position to develop a strategic partnership and positive relationship from the outset. I recommend that your risk management team and TPA sit down and establish a set of realistic program goals. These goals should focus on lowering the overall loss costs for the program, covering everything from settlement authority to use of nurse case management and caseloads. If the goals are unrealistic, it is unlikely that you and your TPA will be able to achieve the expected results, souring the relationship. In addition to being realistic, these goals should be measurable, so that both you and your TPA can continue to monitor progress and make adjustments as necessary.

Metrics and key performance indicators (KPIs) that reflect the success of your program should be determined so that the progress of your program and the performance of your TPA can be measured. I also recommend that you determine checkpoints throughout the year to review these metrics to confirm that they are the most appropriate way to take the pulse of your program and that your TPA is hitting its goals.