TPA Profitability & Operations
The Hidden Cost of Running a TPA in 2026: Plan Builds, Eligibility Calls, and the Margin Problem Nobody Talks About
Your operations team is spending 28% of profits building plans for clients who leave in under three years. Your claims staff is fielding eligibility calls that should never reach a human. Here's the math — and what the highest-margin TPAs are doing differently.
Coming Soon
How to Prepare Your TPA for a DOL Audit Before the Notice Arrives
The TPAs that clear audits in hours — not weeks — built their systems for auditability before they needed it. A step-by-step guide.
Coming Soon
Why Stop-Loss Carriers Are Winning More Disputes — and What TPAs Can Do About It
Carriers have gotten more sophisticated. The TPAs keeping their stop-loss revenue have one thing in common: documentation that starts at the rule level, not the claim level.
Coming Soon
Version Control for Health Plans: Why "We Updated the SPD" Isn't Enough
Plan documents change. Claims logic should change with them — with a complete history of which rule applied to which claim on which date.