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International TPA Services

International TPA Services

International TPA Services

Real international Third Party Administration services (TPA) can only be managed when the organization providing the services is international.

 

Europ Assistance - Global Corporate Solutions (GCS) is able to support Health Carriers and Insurers through different solutions, industrialized like U.S. Cost Containment, with high efficiency and results or customized according to the requirements of our clients and their members.

In an ever changing and increasingly global economy, many employers have chosen to expand internationally in order to establish a global workforce that better meets the challenges and needs of their customers worldwide.

As a result of this global expansion, employers have been forced to re-evaluate their health insurance programs in order to ensure they are providing their employees on international assignments, with a level of healthcare coverage comparable to that received in their home country.

Value Chain

As a leading international third party administrator (TPA) and health management company, we help employers address the challenge of ensuring their employees receive a level of healthcare coverage comparable to their home country. We provide a world-class program where our international proprietary provider network, medical case management, strong claims processing system, customized services and technology are all seamlessly interwoven. Our ultimate aim is to provide the best possible medical care for employees, while reducing and controlling employer’s risks and costs.

Our International TPA Services Value Chain Includes:

 

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24 hour Medical Case Management & Emergency Assistance

Our highly trained and experienced medical management team works together to manage all aspects of an insured member’s case; from initial contact to completion of medical treatment. Our goal is to provide empathetic patient advocacy, while effectively monitoring and managing our clients’ costs. With a centralized hub located in Toronto, Canada, we provide 24/7, 365-days-a-year access to:

  • Dedicated multilingual case management and assistance teams, as well as access to a language line with over 170 languages
  • 22 nurses and 3 physicians who provide medical management and oversight
  • Support in accessing emergency, routine and planned tertiary care
  • Steerage of patients to cost effective providers while maximizing available benefits, coordination of admissions, monitoring of treatment, as well as constant patient support
  • Coordination of air ambulance and commercial evacuation
  • Assistance with direct billing with the provider should a member find themselves referred to a non-network provider
  • Cashless billing coordination
  • Direct toll free numbers or assisted toll free numbers to allow members easy access to reach the assistance centre 24/7
Worldwide Medical Networks

We continually work to enhance and expand our Corporate Medical Network™ (CMN™). New contracts are signed on a daily basis and the network includes industry leading hospitals, doctors, specialists, dentists and other medical providers in over 130 countries.

 

We know that members need more than just hospitals for their daily healthcare needs. The main contributing factor to any successful expatriate plan is to have access to all services. Some TPA’s will boast about their hospital count when in reality a member will most likely seek services from a lab, pharmacy or general practitioner’s office, but we focus on all areas of the medical field when it comes to contracting.

 

More important than the size of the network, is the quality of the providers selected.

 

Our team of dedicated Provider Relations Network Specialists is actively contracting with healthcare providers around the globe. In order to ensure we are consistently working with the best providers at the best price, we regularly review and evaluate our contractual relationships with all our providers while building relationships with the best providers in the region.

 

Inside out January 2013  

 

A Worldwide Presence by Europ Assistance:

 

  • 10,000 acute care facilities
  • Over 600,000 physicians across 130 countries
  • Over 5,000 international facilities with cashless service

 

U.S. Cost Containment & International Medical Expenses Optimization

Our long history of bringing people to the U.S. to access healthcare has allowed us to build an unparalleled direct contract provider network with industry leading discounts.

 

Combine our direct network, along with access to best-in-class HMO and PPO networks, and refined cost-based negotiations for a solution that will help reduce our client’s healthcare costs.

 

Our capabilities and performance in the U.S. market include:

  • Over $500 million worth of U.S. medical bills and over 300,000 claims processed every year
  • Highest net savings in the industry
  • Broad access
  • Best in class discounts with key Centers of Excellence

 

Cost containment services in the U.S. are the most developed in the world and are managed through industrialized processes. In 2007, Europ Assistance identified other locations where the markets were mature to duplicate some best practices for medical expenses cost containment.

 

GCS’ dedicated International TPA skills center has extended its capabilities in the U.S. to the rest of the world, and is able to adjudicate medical claims from all countries where the CMNTM is developed.

Claims Management Services

Our medical claims experience covers all facets of the claims process and is backed by a system that allows for customized support and tracking of each client's specific processes and needs. Our detailed reporting and consultative analysis further enhances these partnerships. 

We work with our clients to create a specific claims management process that works for their needs. 

Online Web Portal Services

Our web-based portal is available in real time 24/7, 365-days-a-year and connects employers and employees to our claims management system through a fully secure web service. Once successfully signed on, users have a number of different tools at their disposal including:

  • Coverage Profile - provides an overview of insured and dependent information with respect to the available coverage and a high level view of available benefits.

 

  • Temporary ID Cards - in the event that a member misplaces or loses their ID card, a temporary ID card can be printed until a replacement card is sent to the member.

 

  • Deductible and Out of Pocket Accumulators - if applicable, this allows members to view the portion of their cost that has been paid to date and what remains.

 

  • On-Line Documents - are available for members to access their policy guide, pre-authorization forms, claim forms and a host of other resources.

 

  • Claims List
    • Within 24 to 48 hours of submission, members can check the status of their submitted claims; the claim does not need to be processed in order to be able to view it online
    • Ability to drill down on each claim to understand how it was processed, as well as access to the Explanation of Benefits
    • Claims transaction history is available since inception

 

The web portal gives users comfort of an on-demand connection to us, while behind the scenes analytics allows us to research traffic and trends.

Reporting Capabilities & Statistics

We understand the importance of keeping our clients informed and providing them with access to a robust suite of detailed reports that provide insight into performance, customer service, claims, and program utilization by employees. Some of the detailed reports available to our clients include, but are not limited to:

 

Financial Reports

  • Claims Paid Report
  • Provisions (Outstanding Claims) Report
  • Estimated Cost Analysis Report

 

Claims Reports

  • Claims Lag Report
  • Large Claimants (over $5000) Report
  • Total Claims Counts
  • Utilization by Service Category
  • Utilization By Diagnosis Group
  • Number of Claims Received but Not Yet Paid

 

TPA Performance

  • Case Management Metrics
  • PPO Network Savings Reports YTD
  • Call Centre Reports
  • Turnaround Time Report for both Member reimbursements and Provider payments
  • Phone Statistics for incoming calls
  • Web Portal Utilization Report