What is a "third party administrator (TPA)" in the health care
insurance industry? Which are the largest TPA's? Are there any
publicly traded TPA's?

Hi factandcomment,

 
   Good day.  According to HealthFirst, "Third Party Administrator" or
"TPA" is an organization that performs insurance administrative
services for:
1. Any plan;
2. Any insurance carrier; or
3. Any organization that self-insures;
Source :: http://www.hftpa.com/whattpa.html

   As far as the biggest TPA is concerned, an article published late
1999 :

Acquisition makes UICI biggest TPA in country
http://dallas.bizjournals.com/dallas/stories/1999/10/18/newscolumn1.html
UICI has announced plans to acquire HealthPlan Services Corp. early
next year through a stock-for-stock transaction for nearly $215
million.

Some of the other big TPAs are
Advanced Data Solutions
http://www.adshealthcare.com/
Third party administrator of employee benefits for small businesses
and large corporations.


Claim Management Services, Inc.
http://www.cmsins.com/
Third party administrator (TPA) specializing in customized self-funded
employee health benefit plans offering a variety of insurance
management services nationwide.


Coastal Administrative Services, Inc.
http://www.coastaladmin.com/
A TPA located in Washington with the focus on self-insurance. Medical,
dental, vision, MSA plans, FLEX, Section 125 and Cafeteria plans are
offered.
Marsh Advantage America - A service of Seabury & Smith, Inc., designs,
manages and administers insurance programs for businesses,
associations and affinity groups, educational institutions,
non-profits, and individuals.


Medical Bill Management 
http://www.medicalbillhelp.com/
Health insurance administration for consumers. 


PenGroup 
http://www.pengroup.com/affiliates/midstate
Handles the enrollment process, eligibility, underwriting, check
writing, and complete data entry of medical claims.


Pilgrim Insurance Company 
http://discoverpilgrim.net/
Provides outsourcing, third-party management and operational services
to property and casualty insurers and self insureds.


RH Administrators 
http://www.rhadministrators.com/
Third party administrator for health insurance claims.


I hope this answers your question. If you have any clarifications to
make, please don't hesitate to ask. If you're happy, then so am I :-)

Have a good day.

Cheers,
aditya2k

factandcomment, 
 
Here's some additional information for you.

According to the National Association of Employee Benefit
Administrators (NAEBA - http://www.naeba.net), a TPA is defined as:

"A Third Party Administrator (TPA) is a supervisor of health plans for
employers who self insure their employee medical benefits."

A TPA is essentially an outsourcer that works with a companies and
organizations on many aspects of their medical benefit plans. These
responsibilities could include:

- Assisting management with plan development, implementation, and
management
- Maintaining plan flexibility to help control costs and provide for
future needs
- Premium collection and claims payments
- Working with health care providers
- Monitoring medical expenses to the employer 
- Customization of benefit plans to suit the sponsor's needs
- Confirmation of plan funding and reserves
- Computerization and automation of plan records, services and tasks
- Provisions for adequate stop-loss insurance
- Compliance with government regulations, including the Employee
Retirement Security Act of 1974 (ERISA), which sets minimum standards
for the establishment and maintenance of a plan by its fiduciaries.

Although a TPA focuses mainly upon the needs of employers, they can
also review employee eligibility, address specific employee needs, and
provide communication between employers and employees.

Good statistical information is scarce, but the Society of
Professional Benefit Administrators has some information:

How do I find good statistics on TPAs and the TPA industry?
http://users.erols.com/spba/p0000010.html

State of the TPA Industry + Forecast As of December 2001
http://users.erols.com/spba/p0000032.html

Forecast & Analysis of the Health Employee Benefits Costs and
Marketplace
http://users.erols.com/spba/p0000030.html 

TPAs Rated as Hot Trend in Future
http://users.erols.com/spba/p0000012.html

What's the Size, Role & Future of TPA's Marketplace? 
http://users.erols.com/spba/p0000015.html

Thanks,
huntsman

References - 

National Association of Employee Benefit Administrators
"The Role Of TPAs"
http://www.naeba.net/tpaframe.htm

Society of Professional Benefit Administrators
"Everything You Wanted To Know About TPAs But Were Afraid To Ask"
http://users.erols.com/spba/p0000010.html

Delaware Healthcare Association 
Glossary of Health Care Terms and Acronyms
http://www.deha.org/Glossary/GlossaryT.htm

USLaw.Com
Employee Benefits - Health Insurance  
http://www.uslaw.com/vsimplify/Health_Insurance.htm

U.S. Department of Labor
Small Business Handbook
Employee Retirement Income Security Act (ERISA)
http://www.dol.gov/asp/programs/handbook/erisa.htm

Employment Law Information Network
"Employee Retirement Income Security Act"
http://www.elinfonet.com/ERISAsum.php

FinancialCounsel.Com
"Beware of ERISA Responsibilities"
http://financialcounsel.com/Articles/Investment/ARTINV0000018-BewareOfERISA.asp


Search Terms & Google URLs - 

"third party administrator" TPA "health care"
://www.google.com/search?sourceid=navclient&querytime=IV-ZG&q=%22third+party+administrator%22+TPA+%22health+care%22

"Employee Retirement Security Act of 1974" purpose
://www.google.com/search?sourceid=navclient&querytime=ALNW&q=%22Employee+Retirement+Security+Act+of+1974%22+purpose

ERISA summary
://www.google.com/search?sourceid=navclient&querytime=ALNW&q=ERISA+summary