Sinelli and Associates, Inc. -- Solutions -- TPAs

Case Studies

Large TPA
Sinelli and Associates, Inc. led an effort to simplify claims processing from 16 systems into one system for one of the largest Third Party Administrators of medical claims in the country. The entire goal of the project is to improve productivity and the "bottom line". The project also includes five or six other systems associated with processes that occur before and after claims processing. Certainly, a critical criteria is subsequent profitably reporting. For a TPA, the reporting includes extensive cost accounting and analysis.

The actual functionality being implemented includes a workflow systems to move the company to "paperless processing", scanning, imaging and data capture, outsourced repricing functions, outsourced EDI data input, totally refurbished claims processing (including optimal automated adjudication), and a centralized mailroom for check and explanation of benefit distribution.

The engagement requires managing approximately 30 professionals and has spanned several years.