No broker or employer is expected to know every question in this series, or what every answer means. I have written them out so you can use them. Putting them together, knowing which threads to pull and what one answer means next to another, is the work I do with plans and brokers in Under the RFP.
Start with what your plan needs
A sales presentation will make every TPA sound like the answer. The way through is to rank your own priorities before you compare anyone. Most plans lean toward one of three profiles, and each one changes where you should dig.
| If your priority is | The TPA you want is strong at | Examine most closely |
|---|---|---|
| Hands-on service | Account management that covers operational gaps with manual work | Account manager depth, turnover, escalation paths, SLAs |
| Technology and automation | Software and operations that run cleanly with light service | Claims system, plan build, auto-adjudication, reporting |
| Pre-integrated partners | Plugging your PBM, medical management, and networks into the plan | Integration ownership, file testing, who runs point when a feed breaks |
None of these is the right answer. A software-forward TPA with thin service can be an excellent fit for a plan with a strong broker who covers the service side. A service-heavy TPA can be the right fit where the plan design is complex. The point is to know which one you are buying.
The nine areas that decide how a TPA performs
This series covers the places administration most often breaks, one post at a time:
What the TPA actually administers: in-house work versus white-labeled and aggregated work.
03How claims reach the right network and benefit tier.
04Plan build and auto-adjudication.
05Implementation and vendor integrations.
06The dedicated account manager: background, support, authority, and reviews.
07Account management after go-live when there is no dedicated contact.
08The leadership team and org chart.
09Turnover and tenure by role.
10Accumulators, pharmacy data, stop-loss, and cash pay.
Read answers for what they mean
There is rarely a wrong answer, only an answer with consequences. A slower file transfer method can still produce fast claims turnaround if the process is run well. A low auto-adjudication rate can be fine if the claims team has real benefit expertise. Medical-only reporting can be simpler than a blended feed. Your job is to understand what each answer means for your members, then decide if you can live with it.
Watch for flat answers. “We can integrate with anyone,” “we take that into consideration,” and “we test for 30 days after go-live” are starting points. Each one should lead to your next question.
Timing matters this fall
Many plans are finalizing renewals and moving administrators for a January 1 effective date. Diligence done after the decision is made can only describe the risk, not change it. If you are choosing now, build vetting into the selection timeline instead of treating implementation as a later problem.
Frequently asked questions
How long does it take to vet a TPA properly?
It depends on the number of finalists, but a thorough review involves written responses plus live conversations with operational staff, not only sales. Build that time in before the contract is signed.
Should I only talk to the TPA’s sales team?
No. Ask to speak with people who run claims, plan build, and integrations. If every question routes back through sales, note that.
What is a common TPA vetting mistake?
Comparing TPAs on price and a feature checklist before defining which service model your plan needs.