5 Questions to Ask to Evaluate Your TPA

If you’re a broker assessing your new or current third-party administrator (TPA), you’ve probably asked the obvious questions about fees, network size, and claims turnaround time. These are important, but they only tell a part of the story.

What happens if a member calls, confused about a bill? Who picks up the phone when a claim gets mistakenly denied? And does your client’s day-to-day experience actually match what was promised in the pitch?

Ultimately, the best TPA isn’t necessarily the one with the lowest administrative fee. It’s the one that consistently gets service right for every member and every client. These 5 questions will help you really evaluate your TPA beyond just price.

How responsive is your service team?

Ask what a member or plan administrator should expect when they call. Is there a dedicated team who knows the account, or a call center with no continuity of assistance? What’s the average response time? What happens if a question needs to escalate?

Claims processing speed is easy to measure, but service responsiveness is harder to see until something goes wrong.

Who is accountable if something goes wrong?

Self-funded plans may involve several vendors. If something breaks, it’s easy for each vendor to blame the others.

A strong TPA can tell you exactly who resolves an issue that crosses vendor lines, and how quickly they commit to solving it.

How do you support members beyond claims processing?

A good TPA will tell a member what to do after their claim is processed, whether lower-cost and higher-quality options exist, or how to navigate a new diagnosis.

Do they offer care navigation? Do they guide members toward higher-value providers or help them understand options before a costly procedure? This is where administrative cost savings can really add up.

What reporting and insights do you provide?

Useful reporting shows where costs come from, which conditions drive spend, and utilization trends – all with enough time for a broker or benefits manager to act on this information.

Ask how often data is available and how it’s delivered.

How well does your TPA integrate with other vendors?

If your self-funded plan works with several vendors on top of your core plan, it’s crucial that each of these systems communicate effectively to ensure a smooth experience for members.

Ask how the TPA shares data and coordinates with a plan’s other vendors. Integration makes an employer’s benefits feel like one thoughtful experience instead of a pile of disconnected tools.

OneVeracity: the TPA that does it all

Any TPA can hand you a fee schedule, but few can tell you what they do when a member is confused, a claim is contested, or a client wants to really understand where their money is going. These real-life scenarios determine whether a plan actually works long-term.

That’s the thinking behind OneVeracity’s Health Solutions, which includes TPA services. We’ve built our claims administration, care navigation, pharmacy benefits, and data reporting to work together, with one accountable team behind them.

With OneVeracity, members get guidance, benefits managers get real answers, and brokers get a partner who prioritizes quality care and cost savings.

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