Transitioning TPAs: What to Consider

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

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

Agenda Topics • The RFP Process • 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

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

The RFP Process: TPA Atlanta RIMS Educational Conference

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

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 Atlanta RIMS Educational Conference

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

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

Before You Start • 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 • 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 Atlanta RIMS Educational Conference

Let’s Get Started • 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 • Internal Change Notice • 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 Atlanta RIMS Educational Conference

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

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

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

Transitioning TPAs: What to Consider