Direct contracts are established with local employer groups who design their own benefit plan for their employees and have contracted with Community Health Partners so that these employees will have a network to access.
These employer groups are considered self-insured because they have designed their own plan of covered medical services and utilize their own funds to make payment on those services.
Third Party Administrators (TPAs) are often contracted by self-insured employer groups to administer their employee benefit plan. Services contracted to TPAs commonly include claims payment, verification of eligibility and benefit information, pre-certification, and utilization review. The name of the TPA will usually appear on the member’s ID card and on any remittance advice or EOBs . Most of the time, however, the name of the employer will not appear on the ID card. This information will need to be supplied to providers by the member.