The Alliance | TPAs - Timely Payment of Claims


TPAs Home The Alliance Connection Help, Information, Answers About Self-Funding Alliance Logos TPA Toolkit Contacts	Home :: TPAs :: TPA Tookit Timely Payment of Claims The Alliance has 3 working days after receiving a claim to forward that claim to the plan administrator. Some Alliance participating providers have contract language with The Alliance that includes the following language: Claims that remain unpaid for more than 30 days may result in the loss of The Alliance negotiated fee to the employer/employee. For this reason, we encourage third-party administrators to pay all claims in a timely manner. Electronic Transmission of Claims Can Speed Claims Payment If you currently don't receive claims electronically from The Alliance, but are interested in establishing EDI connectivity, please contact Dave Sell, 608.210.6656. Need More Information? See page 23 of your TPA Toolkit. Alliance Status Messages Status messages are crucial to determining the level of payment on the claim. The information here will help you understand these messages. Bundling of Charges On occasion our Third-Party Administrators (TPAs) will ask us to alter codes as submitted by the provider to mirror codes identified as appropriate by their bundling software and to obtain corrected repricing. We are not able to assist with these requests. Creating a Clear Explanation of Benefits Creating a Clear Explanation of Benefits Clear Explanation of Benefits (EOB) and Provider Remittance Advices are very important. Creating and Issuing Accurate ID Cards Creating and issuing accurate ID cards guarantees that employees receive appropriate Alliance savings. It also prevents misdirected claims and telephone calls, and leaves customers satisfied. Modifiers The Alliance repricing reflects multiple surgery and other modifier reductions where appropriate. Non-Covered Benefits Many Alliance participating providers have agreed to accept Alliance repricing as full payment whether or not the service is a covered benefit under the plan, and whether or not the employer, their plan administrator, or the employee is responsible for the charges. Service Area County ZIP Code Listing Alliance repricing applies to all participating and non-participating providers in this ZIP code range. Timely Payment of Claims Timely payment of claims is important because claims that remain unpaid for more than 30 days may result in the loss of The Alliance negotiated fee to the employer/employee. What Does The Alliance Not Reprice? The Alliance does not reprice all claims.