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A hospital or provider organization desiring to set up its own health plan will often outsource certain responsibilities to a third-party administrator. For example, an employer may choose to help finance the health care costs of its employees by contracting with a TPA to administer many aspects of a self-funded health care plan.
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
In general, the plan administrator is the employer—but new trends in the industry are seeing more and more groups outsourcing plan administrator duties to TPAs or other entities for a fee. Employers that sponsor self-funded insurance plans often contract with a third-party administrator (TPA), which is an entity that provides ministerial ...
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
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The IPA assembles care providers in self-directed groups within a geographic region to invent and implement health improvement solutions, form collaborative efforts among care providers to implement these programs, and exert political influence upward within the community to effect positive change. [citation needed]
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Even for those that did manage to enroll, insurance providers later reported some instances of applications submitted through the site with required information missing. [30] In Bloomberg Businessweek journalist Paul Ford summed up the issue by remarking, "Regardless of your opinions on the health-care law, this is the wrong way to make ...