TPA Partnering

For those TPAs who have fully explored the new Drug Cost Reporting Requirements, you are likely aware that this effort will require coordination between you (as the TPA) plus the Plan Sponsor and PBM.  Specifically, you lack some of the data necessary to complete your portion of the data files.  As we consult our TPA clients, this often comes as a surprise.

This creates a precarious situation for TPAs since ultimately if anything falls through the cracks you will likely end up being blamed.  The marketplace is under the impression that the PBMs ‘have it all covered‘ since, after all, this is supposed to be Drug Cost reporting.  In reality, PBMs have a complex set of questions to consider in determining their optimal strategy and very often will decide not to report on behalf of plan sponsors.

This creates a very challenging set of circumstances for the TPA as the workload regarding completing this requirement falls back into your lap.  It was for this reason we developed our solution to:

• • Consult TPAs through understanding their options and develop their strategy
  • Assign a dedicated account manager
  • Collect all PBM contact information so our team can begin to coordinate all reporting files from those vendors
  • Assist with data configuration through our relationship with SelfInsuredReporting.com which is used to collect all de-identified medical claim and enrollment data necessary for accurate reporting 
  • Collect basic plan sponsor information from TPA
  • Launch our proprietary software and processes to assist all parties through the process, including the collection of all necessary plan sponsor data
  • Merge all data sources and generate necessary reporting
  • Submit all reporting
  • Service plan sponsors and their brokers on an ongoing basis as questions or audits arise

One of our main goals for TPA clients is to ensure you aren’t blamed for not completing the reporting when in reality you control only a portion of the data for this entire requirement.