Your Role as a TPA or Broker
New technology and platforms seem to appear overnight, and it can be a struggle to keep up. The unfortunate truth behind this rapid change is that it is necessary to stay one step ahead of bad actors who pose a threat to your data and clients’ sensitive medical information.
That’s where you come in. As a TPA or a broker, you have a fiduciary responsibility to your clients to keep their data safe and secure. Using or recommending an outdated platform can expose client data to security threats, and in the event of a breach, you may face significant financial and legal repercussions.
The Risks of Outdated Systems
Legacy platforms weren’t designed to meet modern transparency mandates. The No Surprises Act and Transparency in Coverage Rule require machine-readable files and price-comparison tools, features that older software may struggle to implement. A modern solution, like IPS’s Transparency+, provides all of the tools you need to maintain compliance without expensive development costs. Transparency+ is a stand-alone claims processing system and cost estimator built on Salesforce that seamlessly bolts on to any existing system. It covers the key points required by the No Surprises Act, such as the network status of each provider and facility, contract rates for services for in-network providers, and more.
Older software often has gaps in its utility, which means manual workarounds and fragmented integrations. A full-stack technology solution, such as IPS’s Encompass+, can easily manage the process from beginning to end. Breaks in the digital chain can cause issues with record keeping, and the potential for human error invites risks that can be costly. A workflow management platform that provides end-to-end functionality mitigates the potential fiduciary risk that comes with an incomplete digital record.
Aging systems are also very prone to data breaches due to outdated methods of encryption. Maintaining an up-to-date software infrastructure is essential to protect you and your clients’ data. IPS’s focus on cloud-based architecture, powered by Salesforce, offers modern safeguards to mitigate possible fiduciary risk.
Actions You Can Take as a Broker or TPA
There are actions you can take as a TPA or broker that will help you avoid potential fiduciary legal action.
- Audit Your Platform: Brokers,reach out to your clients and determine how old their systems are and if they support modern transparency and security practices. TPAs, ask yourself and your teams the same question: Is our tech stack compliant and up-to-date to handle the latest regulations?
- Question Vendor Readiness: Ask about implementation times, data handling, the frequency of upgrades, and compliance features.
- Quantify Fiduciary Exposure: If you or a client has a system that doesn’t meet modern standards, you may be at risk.
- Document Your Due Diligence: Keep records of your systems and why they meet fiduciary standards.
- Transition Proactively: Ensure that your systems are up to date with any upcoming standards before they come into effect.
IPS Offers a Solution
Integrated Payor Solutions has what you need to help you mitigate your fiduciary risk. We design every tool with future regulations in mind. Encompass+ provides you with a Salesforce-powered, modern, full-stack solution that keeps all your data in one easily managed platform. Transparency+ is more than just an add-on; it’s designed to adapt to shifting compliance requirements as new legislation continues to be introduced.
Our software also seamlessly integrates with many essential tools you likely already have, such as Outlook, QuickBooks, Checkeeper, and many other industry clearinghouses. This allows your separate systems to work together and minimizes the risk of data silos, which can create costly errors.
Updating and maintaining your software is more than just modernization; it’s a proactive fiduciary protection. Encompass+ and Transparency+ offer TPAs and brokers a future-proof foundation: compliant, integrated, secure, and built to scale.
When the cost of inaction is fiduciary exposure, modernization isn’t optional; it’s essential.
