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TPA Checklist
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TPA Checklist
TPA Checklist
To ensure our plan will run smoothly, please complete the following checklist.
Step
1
of
3
33%
General
Agency Name
*
TPA Name
*
First
Last
Phone
*
Email
*
Has your business entity had a change of name and/or used a d.b.a, or is it operating under an assumed name?
*
Yes
No
If yes, previous name was
*
What is your typical timeframe to integrate with vendor partners?
*
Who will we be working with on this integration? Ex. Implementation Manager, IT/EDI, Service contacts, etc
*
Will these contacts be available for regular stand-up meetings to discuss progress?
*
Do you have experience servicing a client using Reference Based Pricing?
*
Yes
No
If yes, how long have you been working with RBP?
*
If yes, with what RBP vendors do you have experience?
*
EDI
Which claims administration system do you use? (Provide specifics on both hardware and software)
*
How long has your organization used this system?
*
Do you anticipate transitioning to a new system in the next 12 months?
*
Yes
No
Please describe the level of flexibility to your claims system related to making changes.
*
Do you have internal resources that prioritize these needs or do you work through a claim system vendor?
Can you produce test data to engage in testing scenarios?
*
Yes
No
Do you support 5010 834 eligibility files?
*
Yes
No
Do you support 5010 837 claim files?
*
Yes
No
Do you use a clearinghouse for claims traffic?
*
Yes
No
If yes, will you...
*
send claims directly to ClaimDOC
send them to the clearinghouse first
Name of vendor
*
Have you worked with other vendors that send an 837 invoice file as an invoice for services rendered?
*
Yes
No
Do you have the ability to print multiple message codes on each EOB/EOP to communicate the pricing accurately?
*
Yes
No
Are you able to accept ClaimDOC's allowed amounts as the payment methodology?
*
Yes
No
Service
Do you offer additional products or programs in addition to the core TPA functions?
*
Yes
No
If yes, please describe
*
Do you use a vendor to generate ID cards, EOBs and EOPs
*
Yes
No
Can you customize your ID cards?
*
Yes
No
Can you customize your EOBs and EOPs?
*
Yes
No
Do you have a claims portal?
*
Yes
No
If yes, can you provide us access to your portal to view/download ID cards, EOBs, and other claim details?
*
Yes
No
Do you have the ability to suppress EOBs and EOPs from the portal and from being sent to members and providers?
*
Yes
No
Do you have more than one customer service location?
*
Yes
No
If yes, how many locations?
*
What are your customer service hours of operation?
*
