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TPAs

Position yourself as an indispensable TPA

Third Party Administrators

TPA’s need to be able to effectively deliver their customers cutting edge catastrophic claims understanding that can easily justify premium prices and be rewarded for the fiduciary responsibility often associated with claims administrators.

 

With the Predict Suite TPAs can:
  • Achieve up to $194,000 in savings from a typical 1,000 covered life pool by proactively managing reimbursement pitfalls
  • Reduce or eliminate the reliance on and fees from outside vendors (underwriting, negotiation, cost containment)
  • Create a new profit center by putting negotiation fees back in your pocket.
  • Negotiate from a position of strength using data analytics and by understanding what treatments are currently being paid at.
  • Eliminate the quote bottle neck associated with the labor intensive process of researching and quantifying costly diagnoses
  • Join the growing trend of TPAs who are solving the catastrophic claims problem with technology and data analytics products

 

In a typical TPA managing 6000 covered lives, the Predict Suite delivers on average:
  • Over 1.1M reduction in claims dollars (Claims >$100,000)
  • 9x Return On Investment
  • An additional 200k savings in cost containment fees.
  • A more favorable Stop Loss Premium profile

PredictRx provides our specialty pharmacy nurse case managers with real time, actionable data on what we should expect for reasonable costs for these expensive drugs. We are able to take prompt and effective action on the problem drugs to deliver positive results for our clients saving them big dollars right away—a win for our customers and a win for our stop-loss partners.

 

PredictDx offers bountiful context around large claimants which helps lower laser exposure or unreasonable increases in stop-loss premiums for our customers.  It is also helpful when we are providing self-funded quotes to prospects that are coming from a fully insured program where claim data is limited. PredictDx can help us paint a picture with that limited data regarding the risk. This helps us guide the underwriting process to a better outcome for all.

 

Both PredictRx and PredictDx produce results that are dramatic and immediate.”

 

– Brooks Goodison, President

Diversified Group