TPA Company

Overview

In 2005, TPA Company initially engaged in a business relationship with JMS to support their Front-end Paper Claim Conversion to EDI, including Mailroom and Scanning. The goal was to replace their current process of mailroom, scanning, and online data entry directly into LuminX by in-house data entry operators. 

Additionally, TPA has already utilized our Plan testing service where we test all provided scenarios to make sure their Plans would pay correctly. Recognizing the benefits of their existing relationship with JMS, in 2010 TPA Company made the decision to expand the relationship by contracting with JMS to supply claim examiner resources to remotely adjudicate claims directly within LuminX.

Approach

JMS was able to assist with their decision by providing dedicated claim examining resources that had previous Luminx knowledge, and they were fully trained with the clients group plans and business rules and ready for production within 3 weeks.  

TPA Company SME’s (Subject Matter Experts) provided training that consisted of 2 Web Based meetings per week for 3 weeks for a total of 12 hours of client training in addition to JMS‘s internal training review. Low production volume was initially implemented for several weeks so that TPA Company could perform 100% audit of their claims and to confirm that the process was working and services levels were meeting or exceeding expectations and full production was approved

Results

  • ISO 9000 Certification
  • SOC 2 Type 2
  • Quick Ramp Up; minimal impact to in-house training resources
  • Trained backup resources available in case of PTO
  • Able to increase production on short notice
  • Quicker claim payment TAT, reduced inventory
  • Processing Cost Reduction up to 60%

–  Fixed-Rate includes Facilities Overhead
–  Ongoing HR and Training support
–  Employee Compensation & Benefits

Conclusion

JMS is currently examining on average 8,000 claims per month, which equates to about 70% of TPA Company claims. We continue to serve them with Front-end Paper Claim Conversion to EDI, including Mailroom and Scanning.