Series
TPA Operations
A level funded plan performs exactly as well as the TPA operating it, and most employers cannot evaluate TPA quality before they buy. The operational series covers the complete TPA function from eligibility management through renewal: what each system does, where it commonly fails, how performance is measured, and what distinguishes a TPA that delivers on level funded's transparency promise from one that satisfies the administrative fee and nothing more.
LFP-05.01
What a TPA Actually Does: The Operational Core of Level Funded Administration
Claims processing is one output of a system where eligibility management, network access, stop loss coordination, recovery functions, and compliance support are all interdependent. …
LFP-05.02
Eligibility and Enrollment: The Most Important and Most Neglected System in the Stack
Every downstream system trusts the eligibility file. A terminated employee who appears active generates claims the plan should not have paid. A new hire who does not appear cannot …
LFP-05.03
Claims Adjudication and Accuracy: How to Measure What Most Employers Never Check
Industry benchmarks for claims adjudication target 97 to 99 percent financial accuracy. Many small TPAs fall below 95 percent. A 2 percent gap on a $500,000 claims fund is $10,000 …
LFP-05.04
Network Access: Leased Networks, Reference-Based Pricing, and the Tradeoffs Nobody Explains Well
Most TPAs do not own provider networks. They rent access from aggregators like MultiPlan or First Health and retain a portion of the discount as margin. Reference-based pricing …
LFP-05.05
Coordination of Benefits and Subrogation: The Recovery Dollars Most Small Plans Leave on the Table
COB and subrogation return real dollars to the claims fund. High-performing TPAs recover 60 to 80 percent of identifiable potential; low-performing TPAs recover less than 30 …
LFP-05.06
Employer Reporting: What Data Actually Reveals and What Most TPAs Hide Behind PDFs
The level funded value proposition rests partly on transparency: the employer sees its claims data and can act on it. A monthly PDF with aggregate numbers delivers compliance, not …
LFP-05.07
The Renewal Process: Where the Relationship Is Won or Lost
A TPA that begins renewal preparation 120 days out, shops multiple stop loss carriers, and presents the employer with clear options retains accounts. One that starts 60 days out …
LFP-05.08
Rating, Quoting, and Underwriting: The Front-of-Funnel Workflows Where Competitive Position Is Made
Rating accuracy and quote turnaround time determine whether a TPA wins the business. A rate set too low creates claims fund deficits the employer absorbs. Set too high, it loses …