1. Changing TPAs: What to Consider
Speakers:
Paulette Harris-Rogers, Sr. Director Risk Management HD Supply
Sharon LaCour, Account Principal
Gallagher Bassett Services
Atlanta RIMS Educational Conference
Feb. 9, 2017

2. 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
Atlanta RIMS Educational Conference
2/9/2017

3. Agenda Topics The RFP Process Transition Timeline
Factors: Client & TPA
Transition Timeline
How Many? How to Combine?
Budget Considerations
Hidden Fees; New & Ongoing Costs
Before You Start
Implementation Plan; Mapping; RMIS; OSHA; Payroll
Let’s Get Started
Run-in Claims; Posting Notices; Physician Panels;
When You Think It Is All Done
Program Management; Adjuster Changes on Legacy Programs;
Atlanta RIMS Educational Conference
2/9/2017

4. The RFP Process: Client
Carrier/Broker Referrals
List of Approved TPAs
Brokers Claims Consultant Insight
Consider Company Size; Geographical Footprint
Bundled v. Unbundled
Current TPA
Check Termination Language
Incumbent Participation
Sourcing Dept./Broker Resources
Help Narrow Scope & Decision for RFP
Interface w/ prospective vendors
Sample RFP Language
Industry Events – demos; peers
RFP Content
Case Scenarios
RFP Response Review
Interview/Review Team BIOs
Atlanta RIMS Educational Conference
2/9/2017

5. The RFP Process: TPA
Atlanta RIMS Educational Conference
2/9/2017

6. Transition Timeline: Basic
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
Atlanta RIMS Educational Conference
2/9/2017

7. Transition Timeline: Practical
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
Atlanta RIMS Educational Conference
2/9/2017

8. 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
Atlanta RIMS Educational Conference
2/9/2017

9. Before You Start : TPA Implementation
Program Set-Up
Dedicated Implementation Team
Expertise and Experience
Implementation timeline and meetings to better understand your operations
Making a change is difficult, work with a TPA that has the experience to lead the project through each step while communicating openly and regularly, as the change is executed.
Custom data capture
Monitors and Measures
Development of your specific account structure and claim instructions
5 W’s – Who, what, where, why and when
Atlanta RIMS Educational Conference
2/9/2017

10. 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 & International
Monopolistic States – State Fund vs Self-Insured
Special State Requirements (CA, TX)
USA Territories
International Capabilities
Atlanta RIMS Educational Conference
2/9/2017

11. Let’s Get Started Internal Change Notice Locations in the Field
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
Internal Transition Team
Provide insight on how to communicate change within field
Alleviate the “From the Top” perception
Atlanta RIMS Educational Conference
2/9/2017

12. When You Think It Is All Done: TPA
Program Management
Risk Management Information System: User friendly with KEY information available.
Development of reports and automated scheduling
Weekly / Monthly open items call schedule – team performance/program changes/staff changes
Details matter: Claim review schedule
Annual stewardship meeting to reflect progress and suggest enhancements
Program Management
Atlanta RIMS Educational Conference
2/9/2017

13. 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
Program Management
Atlanta RIMS Educational Conference
2/9/2017

14. Q&A When you come to the end of your rope, tie a knot and hang on.
- FDR
Atlanta RIMS Educational Conference
2/9/2017