TPA RFP Evaluation Criteria
| Criterion | Weight | Key Questions |
|---|---|---|
| Claims processing | 30% | What is your claims processing accuracy rate? Average turnaround time? |
| Utilization management | 25% | What is your UM program? Prior auth approval rates? Case management outcomes? |
| Analytics | 20% | What analytics do you provide? How do you help clients use data? |
| Member services | 15% | What is your member satisfaction score? Average call wait time? |
| Implementation | 10% | What is your implementation process? Average go-live timeline? |
Reference Checks
Reference checks with current TPA clients are the most valuable part of the evaluation. Ask references: (1) What is the TPA's claims processing accuracy? (2) How responsive is the account team? (3) What is the member satisfaction score? (4) Has the TPA proactively identified cost management opportunities? (5) Would you select this TPA again?
Performance Guarantees
Pro Tip
Negotiate performance guarantees into your TPA contract: (1) claims processing accuracy (99%+); (2) claims turnaround time (90% within 15 days); (3) member satisfaction score (4.0+/5.0); (4) prior authorization turnaround time (24 hours for urgent; 5 days for routine); and (5) implementation timeline. At-risk fees — a portion of TPA fees contingent on meeting performance targets — align TPA incentives with plan performance.