We Aren’t Your Basic TPA

We customize plans to help streamline sales and simplify implementation.

Our Service-First Approach

Respect, kindness, understanding, and humility—these are the values that drive our team to deliver quality TPA services to our clients. Our team of experts guides clients through self-funded, level-funded, Per-Pay-Period Administration (P3), and minimum essential coverage (MEC) benefit plans. Be our guest and receive:

Seconds

Average Customer
Service Response Time

%+

Claims Processing
Accuracy Rate

%
within 3.7 days

Claims Processing
Turnaround Time

  • SELF-FUNDING

    With our self-funded benefit plans, employers can provide employees with a top-notch service experience while still being able to manage costs efficiently. Enjoy the benefits of a comprehensive and cost-effective benefit plan!

  • LEVEL-FUNDING

    Not sure if you’re ready to switch from fully insured to self-funded plans? Our level-funded option provides the best of both worlds by combining the flexibility of self-funded plans with the stability of fully insured plans.

  • P3 ADMINISTRATION

    Our Per-Pay-Period Administration Program (P3) allows employers to offer benefits to their employees that reduce their total taxable income and increase take-home pay.

  • MINIMUM ESSENTIAL COVERAGE (MEC)

    Our MEC plan meets the requirements of the Affordable Care Act, ensuring that our members have access to essential health benefits and preventative care services. Members can feel secure in knowing that their healthcare needs are taken care of!

Delivering impactful solutions lets us place emphasis on our service offerings.

CLAIMS PROCESSING

Claims administration is a TPA’s bread and butter! At Concierge, we handle the following:

  • Verifying eligibility
  • Determining coverage
  • PPO repricing
  • Adjudicating claims based on terms of benefit coverage

PROVIDER NETWORK MANAGEMENT

Concierge establishes and maintains networks of healthcare providers, including doctors, hospitals, and other medical facilities, and manages the following:

  • Negotiation of contracts
  • Settling reimbursement rates
  • Ensuring access to quality healthcare services

CUSTOMER SERVICE

Concierge offers customer support services to policyholders through our dedicated call centers and online portals, and assists with the following:

  • Claims
  • Coverage
  • Benefits
  • Other policy-related matters as needed

PHARMACY BENEFIT MANAGEMENT

Similar to our Provider Network Management service offering, we establish and maintain networks of pharmacies and manage the negotiation of contracts, reimbursement rates, and access to quality care. Our networks include mail-order pharmacies, offering lower out-of-pocket costs for many benefit plans.

COMPLIANCE AND REGULATORY SUPPORT

We stay up to date on regulations and compliance requirement changes. We assist with the following:

  • Managing documentation
  • Privacy regulations

  • Compliance-related aspects of claims administration

REPORTING AND ANALYTICS

Our team generates reports to provide insight into claims data, trends, and utilization patterns. This helps employers:

  • Assess healthcare costs

  • Identify areas for improvement

  • Make informed decisions

WELLNESS PROGRAM

Concierge receives and processes files from Wellness vendors. The team also manages the adjudication of wellness claims and member Explanation of Benefits (EOB).

COORDINATION OF BENEFITS

In cases where an individual has multiple insurance policies, our team can help determine the primary and secondary insurance policies to avoid overlapping coverage and expenses.

CLAIMS PROCESSING

Claims administration is a TPA’s bread and butter! At Concierge, we handle the following:

  • Verifying eligibility
  • Determining coverage
  • PPO repricing
  • Adjudicating claims based on terms of benefit coverage

PROVIDER NETWORK MANAGEMENT

Concierge establishes and maintains networks of healthcare providers, including doctors, hospitals, and other medical facilities, and manages the following:

  • Negotiation of contracts
  • Settling reimbursement rates
  • Ensuring access to quality healthcare services

CUSTOMER SERVICE

Concierge offers customer support services to policyholders through our dedicated call centers and online portals, and assists with the following:

  • Claims
  • Coverage
  • Benefits
  • Other policy-related matters as needed

PHARMACY BENEFIT MANAGEMENT

Similar to our Provider Network Management service offering, we establish and maintain networks of pharmacies and manage the negotiation of contracts, reimbursement rates, and access to quality care. Our networks include mail-order pharmacies, offering lower out-of-pocket costs for many benefit plans.

COMPLIANCE AND REGULATORY SUPPORT

We stay up to date on regulations and compliance requirement changes. We assist with the following:

  • Managing documentation
  • Privacy regulations

  • Compliance-related aspects of claims administration

REPORTING AND ANALYTICS

Our team generates reports to provide insight into claims data, trends, and utilization patterns. This helps employers:

  • Assess healthcare costs

  • Identify areas for improvement

  • Make informed decisions

WELLNESS PROGRAM

Concierge receives and processes files from Wellness vendors. The team also manages the adjudication of wellness claims and member Explanation of Benefits (EOB).

COORDINATION OF BENEFITS

In cases where an individual has multiple insurance policies, our team can help determine the primary and secondary insurance policies to avoid overlapping coverage and expenses.

Concierge is committed to delivering top-of-the-line service.

 

Still not sure if our options are right for you?

Our team is standing by to help.