What is the TPA – Third Party Administrator?
In addition to the community provider network and care coordination process, each plan incorporates a “TPA,” or third party administrator, who is responsible for the claims payment and overall administration of the plan. Whereas the care coordination process will review many of your healthcare services to determine whether they meet the Plan s criteria, the TPA makes all final determinations as to whether a service is a covered benefit, whether your are eligible to receive this benefit, and whether the expense will be paid by the Plan.
