Evaluating a TPA? Consider asking these 5 questions

evaluating a TPA

If you’ve ever gone through evaluating a Third-Party Administrator (TPA), you know it can involve a lot of work, both in setting up the questions and assessing them after the fact. To better understand vendors in a shorter time, consider asking these questions next time you evaluate a TPA.

Question 1: What level of service am I receiving?

In order to determine the level of service you are receiving, you’ll want to consider several factors. These may include:

  • Responsiveness. This includes how quickly they answer inquiries and if they anticipate questions or concerns before you ask.
  • Ongoing Education. Is there a mixture of easily accessible materials for both you and participants? These might take the form of flyers, videos, articles, or online resources.
  • Communication. Does the TPA have a well-rounded approach to communication? It should address operational needs (like plan updates) and industry changes (like new legislation). When there is a change affecting you or your employees, how quickly does the TPA communicate it?

How you define service may include these three components or other items. In the end, ensure that you and your TPA are on the same page about what good service looks like.

Generally speaking, service is often closely tied to how well a TPA is meeting your expectations.

Question 2: Are they meeting expectations?

If you’re evaluating a TPA you currently use, you can flip this question on its head. Instead of examining if the TPA is delivering on everything you were promised at the onset of the relationship, identify the main areas where you are dissatisfied. In other words, look at identifying pain points. This approach gives you a more accurate picture of if the relationship is living up to your expectations.

Again, as with service, the goal is to make sure you and the TPA you are evaluating are on the same page for expectations.

Question 3: How is this TPA rated by industry peers?

When evaluating a TPA, seek feedback from other parties that interact with this TPA. That might mean soliciting opinions from long-standing clients of this TPA, new clients, or current partners. Based on their experiences, you can put together a picture of how well they manage different components, from implementation to takeovers and day-to-day account management.

In addition to receiving information from parties working with the TPA, you might want to ask for specific data. Your questions should allow you to capture data accurately that speaks to the underpinnings of the TPA’s operation. They probably put their most time and energy in the areas where they do well.

For example, asking “What percent of current clients say they are satisfied with [insert quality here]?” Feel free to insert the qualities you have determined most important to you. (Refer to the qualities you listed for questions one and two). e.g., What percent of current clients say they are satisfied with the responsiveness of their account managers?

Question 4: What are their focus areas?

This question should allow you to take question number one a step further. In addition to scrutinizing the service level provided, familiarize yourself with the TPA’s focus areas.

These focus areas should go beyond a list of differentiators, demonstrating that the TPA is dedicated to a few areas where it matters most, including industry trends and legislation, product expertise, and innovative technology solutions, (including security best practices).

Your goal is to assess if the TPA is just talking the talk or if it’s walking the walk.

Question 5: How secure is this TPA?

One of the final items you’ll want to explore when evaluating a TPA is the level of security and compliance it provides. This will include having a secure way to manage sensitive details, like HIPAA-protected information such as PHI and PII, and SOC II compliance.

There are two goals of SOC II. The first is ensuring that a service provider has appropriate controls. The second is to ensure the controls are followed. The critical areas of control include security, availability, processing integrity, confidentiality, and appropriate measures to protect private customer data.

Making the right decision when evaluating a TPA

By asking these questions when evaluating a TPA, you ensure you’re making the right choice for your clients and their employees.