TPA Company

Overview

TPA Company’s business continued to grow with new groups, and they were continuously confronted with the challenges of hiring and training new employees quickly to keeping up with deadlines and turn-around service levels. Recognizing the benefits of their existing relationship with JMS managing our mailroom and paper claim conversion, TPA Company made the decision to expand the relationship by contracting with JMS in 2011 to supply claim examiner resources to remotely adjudicate claims directly within Healthpac.

Approach

JMS was able to assist with their decision by providing dedicated claim examining resources that had previous Healthpac knowledge, and they were fully trained with the client’s 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
  • 2018 – 99.9 Accuracy 99.83 Procedural
  • 2019 – 99.8 Accuracy 99.84 Procedural
  • TAT – 2.2 days (Under expected TAT for their groups)
  • Processing Cost Reduction up to 40%
       – Fixed Rate includes Facilities Overhead
       – Ongoing HR and Training support   
       – Employee Compensation & Benefits

Conclusion

JMS is currently examining on average 20,000 claims per month for TPA Company, and continues to serve them with mailroom and paper conversion services.

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