Changing TPAs: What to Consider CLM004

Speakers: Paulette H. Rogers, Sr. Director Risk Management, HD Supply

Linda Hoenshel, CPCU, Sr. Claims Manager, HD Supply

Learning Objectives

At the end of this session, you will: •  Build a Comprehensive Timeline

–  Manage Legacy/New TPA; Carrier & Internal Action Items

•  Be Familiar with Carrier Considerations –  Sign-off; Fees; Specific Requirements

•  Be Better Prepared for Go-Live Date & After

Agenda Topics

•  Discussion Baseline –  RFP Selection Complete; Working on Transition Plan

•  Transition Timeline –  How Many? How to Combine?

•  Budget Considerations –  Hidden Fees; New & Ongoing Costs

•  Before You Start –  Location Mapping; RMIS Systems; OSHA Recordkeeping; Payroll Feed

•  Let’s Get Started –  Run-in Claims: Coversheets; Indemnity Payments –  New TPA: Posting Notices; Physician Panels; International Locations

•  When You Think It Is All Done –  Adjuster Changes on Legacy Programs; Provider Invoicing Errors

Discussion Baseline

•  RFP Process Complete –  New TPA Selected –  New TPA Fee Determined –  New TPA Already Approved by Carrier

•  Deductible Program –  Some Carrier Involvement: High/Low Deductible or Retention

•  Legacy TPA Termination –  Typical Contractual 60-Day Notice of Termination Language

Transition Timeline

•  Main Decision –  TPA Change During Policy Renewal or Off-Cycle? –  Consider the Size of the Program (Claim Frequency & Transaction Count)

•  Draft Timeline –  Legacy TPA Term Notice in Accordance with Contract (60-Days) –  New TPA Requires a Minimum 90-day Transition Period –  Broker to Notice Carrier

Basic Timeline 30-Day 60-Day 90-Day Go-Live

Legacy TPA Term New TPA

Transition Timeline

•  Legacy & New TPA –  Minimum 90-Days

•  Carrier Timeline –  System Mapping/Testing –  State Notices –  Collateral

•  Internal Timeline –  Payroll/Data Setup –  Mapping –  Notification –  Training

Actual Timeline 30 Day 60 Day 90 Day

180 Day

Legacy TPA

Carrier

New TPA

Internal

Budget Considerations •  Legacy TPA

–  Data Access –  Continued Account Management –  Escrow

•  New TPA –  Escrow for Claim Payments; TPA Fee; Fee for Run-in Claims –  Claim Funding (How Often) –  Monitor Indemnity Payments

•  Carrier –  Charge for the TPA Change –  Change to Loss Pick (Broker Assistance)

•  Financial Considerations v Fiscal Budget

Before You Start

•  Moving Legacy Data to the New TPA –  RMIS System –  Follow New TPA’s Lead in the Mapping Process –  Additional Data You Want the New TPA to Capture –  Correct Errors/Gaps in Information Prior to Moving Data –  Consider Affect to OSHA Recordkeeping & RMIS System

•  Payroll/ Location Updates from Internal Team to the New TPA –  How Often to Update?

•  State Statutes –  Monopolistic States – State Fund vs Self-Insured –  Special State Requirements (CA, TX) –  USA Territories

Let’s Get Started

•  Internal Change Notice –  Notifying Internal Managers –  Internal Documents and Contacts –  Intranet Pages –  Adjuster Contact Information

•  Locations in the Field –  Posting Notices Changed to Reflect New TPA Contact Information –  Physician Panels – Changes for New TPA Network

•  Current Associates on Work Comp –  Notification of the Change –  Keep the Claim Moving (Coversheets/Indemnity Payments)

•  Benefits •  Medical Treatment

When You Think It Is All Done

•  Adjuster Changes on Legacy Casualty Program •  Claims Still Being Reported to Legacy TPA •  New Claims with Prior DOL’s •  Providers Sending Invoices to Legacy TPA •  Adjust to Change

–  New Software –  New Program Manager –  New Adjusters/Training

•  Client Handling Instructions –  Telephonic Claim Review –  Claim Audit

WHEN YOU COME TO THE END OF YOUR ROPE, TIE A KNOT AND HANG ON.

Q&A

- FDR