What is a Third-Party Administrator?

A third-party administrator (TPA) is an organization that manages health insurance claims and administrative functions for self-insured employers without assuming any financial risk. TPAs handle tasks such as processing claims, managing provider networks, enrolling employees, and providing customer service. They act as intermediaries between employers, employees, and healthcare providers while the employer retains responsibility for funding claims.

Why third-party administrators matter

• Provides expertise: Offers specialized knowledge in claims processing and benefits administration
• Reduces employer burden: Handles complex administrative tasks for self-insured plans
• Maintains compliance: Ensures adherence to healthcare regulations and reporting requirements

How Solace can help

A Solace advocate can help you understand the role of your TPA, navigate communication between the TPA and your employer, and resolve claims processing issues. Advocates can also assist with appeals when TPAs deny coverage or make administrative errors.