TPAs | COBRAPoint White Papers

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TPAs

Third Party Claims Administrators
COBRA & HIPAA Compliance Administration

The Current State Of Affairs
Are we doing a service for our clients?

It’s a real jungle out there—yet there’s more opportunity than ever to grow your TPA business in terms of clients and revenues per client. Innovative and forward-looking firms are looking at clients in a whole new light. TPAs across the country tell us that their clients’ employee benefit budgets are being pressed to the breaking point by increasing utilization and reinsurance premium increases. And, it’s becoming more difficult to find new markets for reinsurance coverage, efficient PPO networks and in overcoming the inherent inefficiencies of managing a traditional employee benefits program. So, in the midst of this, where’s the opportunity?

The spectrum of firms runs the gamut from the small business with limited resources to the large publicly traded or insurance carrier-owned TPA with virtually unlimited resources. However, one thing is constant across this spectrum: Each TPA must compete in the same market at the same time. Those finding success are positioning themselves as more than firms that process eligibility and claims—but ones that can identify and solve client problems and do it on a budget.

Subsequently, employers are faced with improving the operational efficiencies of their human resource departments. Just like delegating job responsibilities inside a corporation, smart businesses are now delegating to outside vendors. Firms are recognizing this and driving the conversation with employers. The TPA that becomes a member of the human resources team will have a more durable relationship than the firm that is viewed simply as a replaceable service provider.

Second, firms are leveraging technology and partnerships to enhance their own operational efficiencies, leap-frog past larger TPAs with entrenched legacy systems and create a unique brand identify in what is typically perceived as a largely generic industry. The Internet, e-mail and instant messaging have removed the geographic barriers that once existed for many TPAs and the widely held belief that employers wanted to work with only local companies. Today, firms are reinventing themselves to provide their current and new clients technical resources and skills at an unprecedented rate. Employers really don’t expect that their TPA firm can be all encompassing experts in every thing simultaneously. What they do expect, however, are cutting edge solutions and cost-reducing strategies that deliver documentable results.

COBRA and HIPAA compliance administration is clearly a driver in partnering with the employer client to solve their employee benefit management issues. Most firms have addressed COBRA and HIPAA, but only to a limited degree.

The Challenge
What does it take to develop a world class COBRA and HIPAA compliance unit?

Take a step back for a moment and examine the COBRA and HIPAA compliance solution currently employed at your firm. Most likely it falls into one of these categories:

Stand-alone, pre-packaged software system run locally on your system
An add-on module of your claims system
An internally developed tracking and premium payment reconciliation system
An outsourced COBRA administration firm that operates as your back office

Each of these solutions has its shortcomings. First, data transfer and seamless integration between a pre-packaged system and your claims system is cumbersome at best. Your firm has probably had to write programs to bridge these two systems together.

Second, an add-on module to your claims system solves the data migration problem, but is it robust enough to handle your operations and is it feasible to expect your claims software vendor to serve two masters equally: COBRA and claims? Third, internally designed solutions to COBRA and HIPAA compliance tracking place the firm in a position of having to support the development and upgrades to that system. The traditional firm finds it difficult to devote the required resources to ensure a robust and bombproof compliance system. Typically, one significant threat can cause this firm to reevaluate its strategy.

Finally, many firms have hired professional COBRA administrators to operate as a back office for this specialized service. The firm is able to enjoy limited indemnification and hold harmless protections; however, the TPA’s client relationship is at risk if the COBRA provider’s service standards slip. In addition, the TPA usually has to configure ways to provide the COBRA administrator information on events. Rarely is this a seamless conveyance of data, nor is it transparent to the client.

The Solution
COBRApoint has developed BUSINESS IN A BOX solutions

The Benefit
Simultaneously level the field and generate additional source of revenues

The Technology
The power of an effective application service provider

About the Company
COCO Development, LLC

COCO Development, LLC, provides cutting-edge, business-to-business solutions that facilitate and streamline the complex tasks of managing human resource functions. All COOC Development solutions are accessible in an Application Service Provider environment. Employer customers may access tier-1 technology solutions without significant capital investments or computiong infrastructure reconfiguration

Founded in 2003, COCO Development is being recognized as a leader in innovative HR compliance process applications. Every member of the development and management team has amassed in depth technical and practical knowledge about COBRA compliance administration and instills every facet of COBRApoint with this collective knowledge. For more information, visit www.cobrapoint.com.


>>	TPAs

	Third Party Claims Administrators COBRA & HIPAA Compliance Administration The Current State Of Affairs *Are we doing a service for our clients?* It’s a real jungle out there—yet there’s more opportunity than ever to grow your TPA business in terms of clients and revenues per client. Innovative and forward-looking firms are looking at clients in a whole new light. TPAs across the country tell us that their clients’ employee benefit budgets are being pressed to the breaking point by increasing utilization and reinsurance premium increases. And, it’s becoming more difficult to find new markets for reinsurance coverage, efficient PPO networks and in overcoming the inherent inefficiencies of managing a traditional employee benefits program. So, in the midst of this, where’s the opportunity? The spectrum of firms runs the gamut from the small business with limited resources to the large publicly traded or insurance carrier-owned TPA with virtually unlimited resources. However, one thing is constant across this spectrum: Each TPA must compete in the same market at the same time. Those finding success are positioning themselves as more than firms that process eligibility and claims—but ones that can identify and solve client problems and do it on a budget. Subsequently, employers are faced with improving the operational efficiencies of their human resource departments. Just like delegating job responsibilities inside a corporation, smart businesses are now delegating to outside vendors. Firms are recognizing this and driving the conversation with employers. The TPA that becomes a member of the human resources team will have a more durable relationship than the firm that is viewed simply as a replaceable service provider. Second, firms are leveraging technology and partnerships to enhance their own operational efficiencies, leap-frog past larger TPAs with entrenched legacy systems and create a unique brand identify in what is typically perceived as a largely generic industry. The Internet, e-mail and instant messaging have removed the geographic barriers that once existed for many TPAs and the widely held belief that employers wanted to work with only local companies. Today, firms are reinventing themselves to provide their current and new clients technical resources and skills at an unprecedented rate. Employers really don’t expect that their TPA firm can be all encompassing experts in every thing simultaneously. What they do expect, however, are cutting edge solutions and cost-reducing strategies that deliver documentable results. COBRA and HIPAA compliance administration is clearly a driver in partnering with the employer client to solve their employee benefit management issues. Most firms have addressed COBRA and HIPAA, but only to a limited degree. The Challenge *What does it take to develop a world class COBRA and HIPAA compliance unit?* Take a step back for a moment and examine the COBRA and HIPAA compliance solution currently employed at your firm. Most likely it falls into one of these categories: Stand-alone, pre-packaged software system run locally on your system An add-on module of your claims system An internally developed tracking and premium payment reconciliation system An outsourced COBRA administration firm that operates as your back office Each of these solutions has its shortcomings. First, data transfer and seamless integration between a pre-packaged system and your claims system is cumbersome at best. Your firm has probably had to write programs to bridge these two systems together. Second, an add-on module to your claims system solves the data migration problem, but is it robust enough to handle your operations and is it feasible to expect your claims software vendor to serve two masters equally: COBRA and claims? Third, internally designed solutions to COBRA and HIPAA compliance tracking place the firm in a position of having to support the development and upgrades to that system. The traditional firm finds it difficult to devote the required resources to ensure a robust and bombproof compliance system. Typically, one significant threat can cause this firm to reevaluate its strategy. Finally, many firms have hired professional COBRA administrators to operate as a back office for this specialized service. The firm is able to enjoy limited indemnification and hold harmless protections; however, the TPA’s client relationship is at risk if the COBRA provider’s service standards slip. In addition, the TPA usually has to configure ways to provide the COBRA administrator information on events. Rarely is this a seamless conveyance of data, nor is it transparent to the client. The Solution *COBRApoint has developed BUSINESS IN A BOX solutions* The Benefit *Simultaneously level the field and generate additional source of revenues* The Technology *The power of an effective application service provider* About the Company *COCO Development, LLC* COCO Development, LLC, provides cutting-edge, business-to-business solutions that facilitate and streamline the complex tasks of managing human resource functions. All COOC Development solutions are accessible in an Application Service Provider environment. Employer customers may access tier-1 technology solutions without significant capital investments or computiong infrastructure reconfiguration Founded in 2003, COCO Development is being recognized as a leader in innovative HR compliance process applications. Every member of the development and management team has amassed in depth technical and practical knowledge about COBRA compliance administration and instills every facet of COBRApoint with this collective knowledge. For more information, visit www.cobrapoint.com.

	Copyright © 2004 COBRApoint, a product of COCO Development, LLC 210 South 77th Street - Omaha, NE 68114 877-884-7021 or 402-884-7021 or www.cobrapoint.com