A Third Party for
a Third-Party Administrator

A successful Third-Party Administrator (TPA) must marry the demands of a rapidly evolving business environment with the management requirements of healthcare benefits, the skillsets of an evolving labor pool, and regulatory changes at federal and state levels.

A true 360-degree understanding of all parties within the healthcare ecosystem isn’t just to be preferred, it is absolutely a prerequisite to a thriving business

The traditional understanding of the delicate eco-system among the three critical players in the insurance industry are:

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When a TPA is involved, #3 is not the payor directly, but rather the TPA firm hired to handle the plan and claims between the employer/plan/patient and the medical provider.

This paper examines the business challenges, solutions, and outcomes when Vee Technologies was called upon to take over nearly all claims-related, call-related, and billing-related third-party administrator services for a leading TPA in the Midwest that deploys solutions for employers, professional employer groups (PEOs), associations, brokers, and healthcare providers.

The Client's Problem


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Our client had some serious problems in 2013

  • Turnaround time on repricing and adjudicating client claims was lagging
  • Quality employees were hard to come by in their region
  • Volumes were difficult to predict due to seasonality and a cyclical 'busy season' from November to February that decimated planning, resourcing, and other considerations from a volatility perspective

The client needed a variable approach to fixed problems. They needed high quality talent…rapidly. Nearly all their processes had become highly customized over years of tweaking; their primary electronic system was homegrown and nuanced.

Finding a vendor was necessary, but finding the right partner was critical. Time was also of the essence, as claims were backing up daily.

vee technologies solution


The TPA turned to Vee Technologies for help on all fronts.

In 2014, Vee Technologies put into place single points of contact, communication channels, weekly processes, and frequently visited client sites to build intimacy. Creating this basic framework gave them and us a platform to measure accuracies, validate competencies, and begin the slow process of building teamwork.

Together, the TPA and Vee Technologies have expanded services to over 13 different claims-related, call-related, and billing-related functions. Business has grown year over year since starting the relationship nearly six years ago – helping the company hit record results, increase revenue upwards of 45%, and set up incredible future growth.

Vee Technologies could not have taken over 13 different services, across 3 business verticals, if it was not for the positioning of key personnel at the top, from the start.

Nitin Arora, General Manager of Claims Services at Vee Technologies, managed the due diligence, implementation, ramp up, governance, and review of all services from the Day One. Nitin has been with Vee Technologies since its first payor client, building experience installing a myriad of TPA-related services over a 20-year career.

He states that the key to building out a successful account management model for a TPA is “studying the interoperability of all the different tasks a TPA takes on and building a specifically trained team that can achieve those outcomes across the departments that drive daily activity.”

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Conclusion

While Vee Technologies took on only two service lines in the beginning, it positioned itself to handle all of its client’s challenges, collectively, from the start – whether directly involved or not. This 'eye level' approach is the only way to properly prioritize client needs, contextualize demands, and build a sustainable partnership predicated on achieving long-term outcomes.

As the client's Chief Operating Officer remarked last year, "Nearly three years ago, I was looking for cost-effective and high-quality claims processing support services. We were looking to supplant our internal teams with bandwidth. Vee Technologies quickly set up training, account management, sourced resources, and built processes with my team. Additionally, we have expanded our relationship with them over the last several years. While we originally sourced claims re-pricing and adjudication support services, we have now expanded to have Vee Technologies do our enrollments, reenrollments, adjustments, null/voids, benefit setup, high dollar claims. We are additionally exploring having Vee Technologies take over several claim audit functions as well."

Vivek Venkataram

Meet the Author

Vivek Venkataram - Senior Director Client Services

Vivek has been with Vee Technologies since 2010, currently serving in a Senior Director Client Services role. His focus is on new business development efforts, negotiating agreements, and aligning global, specialized resources with requirements, ultimately responsible for client satisfaction. He graduated from Stanford University with a bachelors degree in Public Policy.

A third party for a third party administrator

A third party for a third party administrator