The definition of “TPA” has expanded significantly since the SPBA first formed in 1975 with more and more types of specialties emerging. As it always has been, SPBA membership continues to be targeted to full-service TPAs who offer comprehensive services to several client plans/employers. We strive to offer the most value to TPAs by providing membership benefits that will be a worthwhile investment. If we feel your company won’t realize maximum value by joining, we will advise accordingly.
Stop-Loss Service PartnersIn 1995, the SPBA created an avenue for Stop-Loss firms to participate in the organization, recognizing that much of the success and growth of self-funding and TPAs had been attributable to the cooperation and coordination with Stop-Loss firms. There was immediate enthusiastic response from leading Stop-Loss players who understood the value of being educated on the latest regulatory developments alongside TPAs. The partnership, known as Stop-Loss Service Partners, plays a key role in explaining and defending the concept of self-funding and Stop-Loss in the face of misperceptions and misunderstandings by government, media and the general public. Like SPBA’s TPA Members, Stop-Loss Service Partners receive SPBA email alerts, UPDATEs and attend SPBA educational meetings.
Technology Service Partners
In mid-2014, the SPBA created a partnership category for technology companies that are dedicated to the TPA industry in certain specific areas (see below). SPBA recognized that technology companies need the education on legislative and regulatory developments to ensure their products and services are in compliance with a myriad of complex rules and regulations. Like the Stop-Loss Partners, the Technology Service Partners receive SPBA email alerts, UPDATEs and they attend SPBA educational meetings.
SPBA welcomes technology companies whose primary business is the development and provision of technology, and/or server software applications required by other entities that process medical claims, such as TPAs, to perform one or more of the following functions:
- Transmit, receive and translate medical claims residing in regulatory required electronic data formats;
- Process, edit, and adjudicate medical claims;
- Communicate the results of such processing to patients and providers, including, but not limited to payments, in regulatory required formats;
- Electronically store/warehouse medical claims;
- Maintain the privacy and security of plan participant health information.