The Processes And Benefits Of Claims Reviews vs. TPA Audits

Claims reviews and TPA audits can ensure that third-party administrators (TPAs) utilize efficient and accurate practices to prevent long-term costs from developing when processing high-dollar benefits claims.

They can resolve a stagnating claim that is holding up closure and increasing exposure by pinpointing more alarming issues, such as under- or over-reserving, injury patterns and improper staffing.

While both techniques are highly effective in minimizing cost drivers, their frequency, process and benefits vary in how a carrier decides their necessity.

‘The carrier’s goal in both a claims review and TPA audit is to identify and manage those glaring concerns that could lead to costly long-tail claims,’ said Angie Roach, Claims Manager at Safety National.

‘It is important to find red flags that can snowball into a much larger problem, like a large volume of claims, or more specifically, failure to report head injury claims or missed return-to-work releases."