What Is Reference-Based Pricing? A Guide for Employers and Benefits Brokers
If you’re asking what is reference-based pricing, the short answer is that it is a healthcare reimbursement strategy commonly used with self-funded health plans. Instead of relying solely on negotiated provider contracts, reference-based pricing reimburses healthcare providers using a predetermined benchmark—often a percentage of Medicare reference pricing. This approach can provide employers with greater healthcare […]
What Does a Third-Party Administrator (TPA) Actually Do?
If you’ve ever wondered what does a third-party administrator do, the short answer is this: a third-party administrator (TPA) manages the day-to-day administration of employer health plans and workers’ compensation programs. Rather than simply processing claims, today’s TPAs coordinate benefits administration, medical claims processing, customer service, reporting, vendor relationships, and cost containment while helping employers […]
Cost Containment Strategies for Employee Health Plans
Healthcare expenses continue to be one of the largest and fastest-growing costs organizations face. Employers across industries are managing increasing medical expenses, rising prescription drug costs, and evolving employee healthcare needs while trying to maintain competitive benefits programs. As a result, many organizations are evaluating ways to improve oversight, gain greater visibility into healthcare spending, […]
How Workers Compensation Claims Administration Works
Workplace injuries can occur in virtually any industry, from healthcare and education to manufacturing, construction, and public service. When an injury happens, employers must navigate a process that involves employees, healthcare providers, claims professionals, and regulatory requirements. This is where Workers Compensation Claims Administration plays a critical role. Many employers assume workers’ compensation claims involve […]
TPA vs Insurance Carrier: What Is the Difference?
Employee benefits administration can be complex, especially when employers are evaluating how health plans are structured and managed. Organizations often encounter both Third Party Administrator (TPA) organizations and insurance carriers, but the roles they play are not always clearly understood. This confusion can make it difficult for HR leaders, CFOs, and benefits managers to determine […]