A prominent Third-Party Administrator (TPA) consolidates the administration of its consumer-driven healthcare accounts for greater efficiency and scalability.
Acclaris’ client is a regional Third Party Administrator (TPA) providing benefit services to 40,000 participants, predominantly FSA but also covering HRA and tuition accounts. While robust, the FSA business was not generating sufficient returns to justify necessary investments in technology, service improvements and support… the lack of which was negatively impacting operations and member satisfaction.
What’s more, the client was not well positioned to compete for new participant accounts due to limitations in pricing, functionality and scalability. To build a long-term CDH strategy, the client considered a range of claims processing and support options. Following a detailed evaluation process, the client selected Acclaris’ financial technology and integrated services.
The Acclaris Solution
Acclaris’ outsourced solution accommodated all of the client’s account types, consolidating them into a single platform with a consistent interface and user experience. Taking advantage of Acclaris’ hosted technology and best practices, the TPA significantly expanded functionality without capital investments or additional overhead.
Components of the solution included:
- TPA-branded member and group web portals that create a seamless extension of the client’s brand
- Self-service access to submit, manage and track claims throughout the reimbursement cycle
- Simplified HRA set-up and administration resulting from a highly-configurable system
- A fully-integrated IIAS-compliant health debit card with industry-leading auto substantiation
- Claims intake and processing, with multiple disbursement options including “pay my provider”
- Customized, US-based participant care services with expanded IVR and full issue resolution transparency.
Having evaluated software-only solutions, the client determined that Acclaris’ unique combination of technology and service would drive the most incremental value, both from direct cost savings and expanded revenue opportunities.
By providing complete visibility into the CDH claims process, Acclaris’ solution provided benefits over and above cost reduction. The client received a reliable, accurate and HIPAA-compliant system, with virtually unlimited operational scalability. Implementation also had a direct positive impact on key stakeholders:
- Participants experienced faster claims turnaround times with greater accuracy, resulting in increased customer satisfaction. A consistent experience across account types reduced perceived complexity, enabling more active management of CDH funds.
- Employers received greater flexibility in set-up and tracking, particularly for complex HRA plans. A high degree of self-service benefited all employers who previously relied on the TPA for performance data. The client was also more readily able to meet localized client demands without customized software development.
- Channel partners recognized the compelling economics and sophisticated functionality they needed to successfully promote the TPA’s offerings in the marketplace, particularly among larger and more complex high-end clients. A robust file feed utility provided a smoother integration with health plans, significantly lowering the cost and duration of implementations.
In terms of financial impact, the Acclaris solution drove significant improvements to the client’s profit margins on CDH accounts. Key cost drivers included the following:
- Conversion to electronic communication, notification and reimbursement dramatically lowered mail/fulfillment costs
- Employee self-service, including on-line help ticketing, reduced volume in the call center by more than 25%
- The TPAs in-house headcount was reduced by 70%
- Debit card costs were reduced by more than 40% and usage rates soared among participants.
With its cost structure more in line with market demands, the client was freed to devote more resources to account management, sales and marketing. With greater plan design flexibility and resource scalability, Acclaris empowered the client to keep pace with the rapidly evolving CDH market.