Third Party Administration (TPA) Services
Keenan’s Employee Benefits TPA offers discounted access to the Anthem Blue Cross provider network and provides comprehensive medical claims administration and customer service. Today, Keenan’s medical benefit TPA administers benefit payment services for over 50 medical plans representing 70,000 members.
Keenan’s Employee Benefits TPA conducts annual audits of self funded plans. Audits draw 100 claims payment transactions randomly, and review them for several classes of accuracy, including payment calculation, diagnosis coding, procedural protocols, eligibility verification, and coordination with other coverage including Medicare, and EOB content. These audits give the employer a greater sense of confidence that the considerable flow of dollars through the self-funded plan is being well managed. We are eminently qualified to conduct this review since we are one of but a few claims administrators in California licensed by Anthem Blue Cross to offer access to and adjudicate claims on their behalf and on their PPO networks.
Our Employee Benefits TPA utilizes Eldorado’s state-of-the-art Javalina system. This system is fully automated and procedure driven, enabling Keenan to send and receive electronic claims submission, priced claims and interface with the BenefitBridge eligibility system.
A great deal of benefits cost is concentrated in a small number of large, catastrophic claims. Again using the resources of our claims administration operation, we will review all self funded plan claims that cumulatively exceed $75,000 during a plan year. We also track the status of where emerging claims are in the payment pipeline to assure they are adjudicated in time to apply to any reinsurance thresholds by the end of a Plan Year.