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At TrueChoice USA, our initial focus is on assisting TPA's. All TPA's need to access strong local and regional PPO's to remain competitive when bidding against fully insured carrier plans. Smaller TPA's however, often do not have capacity to efficiently and profitably perform the PPO management functions required for multi-site employer groups. When these client opportunities arise, these TPA's may decline to bid or turn to "national" PPO's to ease the administrative burden. In either instance, they lose market share or remain non-competitive when compared to the carriers due to decreased provider access and lower provider savings.
At TrueChoice USA, our role is to facilitate the interface between regional PPO's and payors to increase their marketplace competitiveness and to de-leverage carrier strength. We do this by serving as a broker between the entities placing new network access business with each, functioning as an operational backroom for data management and serving as a claims clearinghouse.
We have an additional focus toward assisting regional provider PPO's, and provider based groups to manage the data interface with third party networks and payors. Provider groups are approached daily to join a variety of managed care and/or payor networks which require a data stream to access and reimburse providers. Provider entities quickly find they must staff to manage the quality issues and provider complaints which arise from inaccurate data loads, updating errors, and inaccurate claim repricing. TrueChoice USA serves as an out-source partner for provider groups to facilitate data distribution, perform data audits, and serve as a claims liaison when business issues arise. Ultimately, this allows provider groups to grow the number of third party affiliations they can confidently enter while increasing provider panel satisfaction.
TrueChoice USA is not a PPO. Rather, we work with both payors and providers to give each a single point of access to the other while growing their local market brand. We simplify and facilitate the functions that make local PPO partnerships work.
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