Effectively managing the risk and the cost associated with workers’ compensation is critical to employers of all sizes and in all industries. A single claim has the potential to add significant unexpected cost to a small employer, while ineffective risk and claims management strategies can place larger employers at a tremendous cost disadvantage compared to competitors.
A Third Party Administrator (TPA) serves as an advisor and advocate for employers on workers’ compensation matters. Many Ohio employers, both state fund and self insured, engage a TPA to provide advice and administration services for their workers’ compensation programs.
TPA services begin with an assessment of an employer’s current situation, including any claim history and risk analysis.
In the event of a claim, TPAs provide claims management services from the beginning. TPAs work closely with the employer’s MCO on all claim medical matters, and consult with the employer on alternative courses of action for each claim, keeping in mind cost control for the employer.
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Additionally, TPAs serve as plan administrators for association and chamber sponsored group rating programs. The TPA manages the group program, ensuring the integrity and stability of the group and assisting sponsoring organizations obtain the greatest savings for their members.
TPA Responsibilities Include:
Claims Administration
- Claims Investigation
- Certification/rejection advice
- Outcome management
- Cost control strategies
- Salary Continuation
- Transitional Work
- Lump Sum Settlement
- Handicap Reimbursement
Risk Management
- Financial reports
- Premium projections
- Experience forecasting
- Assessment of alternative rating program options
- Group Rating
- Retrospective Rating
- Drug Free Workplace
- Safety Council
- Payroll Segregation
- Self Insurance
Hearing Representation
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