TPA Office Claim Reporting and Recovery

TPAOffice Claim Reporting and Recovery is an administrative application for managing the communication, reporting, and recovery of specific stop-loss claim submissions, receivables, pending claims and denials, and recoveries with carriers.

Reporting

File specific claim notifications with carriers and MGUs.

File 50% notifications
File diagnosis notifications
Maintain industry and carrier specific trigger diagnosis lists
Import YTD claim summaries from claim adjudication systems with top diagnosis
Work notification filing queues and track history

File specific claims with carriers and MGUs.

File claim submissions
Work claim filing queues and track history
Work claim checklist to create complete filing documentation to send to carrier
Track outstanding claim receivables
Track pending and denied charges
File appeals
Track the final disposition of all claims submissions
Analyze claim turn-around times and first-time payments

Analysis

Track YTD claim charges, diagnosis, claims filed, and stop loss recoverable for all claimants by policy and carrier

Claim Recoveries

Track claim receivables by filed claim, member, and carrier
Manage claim receivables with aging reports
Enter claim receipts and report recoveries to clients

Care Management

Track pre-certifications and surgical and outpatient reviews
Track LCM progress and notes

Renewal Marketing

Assist underwriters with up to date information on ongoing claimants at renewal.

Provide shock loss claim summary
Provide claim details on select claimants
Provide diagnosis summaries ordered by diagnosis with highest dollars spent to lowest
Provide procedure summaries ordered by most recent date to earliest
Provide case management history on select claimants