Sunday, April 27, 2014

The Importance Of TPA License Renewal Compliance

By Eloise Hewitt


Not all states have requirements for third party administrator requirements. The number of states with requirements is barely forty four. Organizations consider the licensing and renewal laws quite cumbersome and uncalled for. They entrust such processes to consultants who ease the burden for them. Corporate adjuster regulations are in force for many states without such requirements. The procedure and documentation may appear the same, but there exists slight variations across states as far as the TPA license renewal compliance is concerned.

Some information is often required by many states as a whole. It is therefore important to obtain a specific checklist concerning the state in which you intend to be licensed or renewed. The checklist and license guidelines save time that could otherwise be wasted in compiling unnecessary information and documents. Some of which may not be needed, according to your states of interest.

The licensing of third party administration is satisfied by the commissioner of commerce. It can only be granted upon satisfying that the applicant is in a position to discharge PTA services. In addition, the administrator must be financially sound and able to process claims within the time and equitably.

When applying for renewal, the applicant shall have fully adhered to the license report compliance in the previous year of operation. Report compliance is a clause in the registration form requiring the licensee to file or ensure the clients it serves file all the reports required. These reports relate to the services provided by the administrator within the times spelt out by the rule, statute or commissioner's order.

The files are detailed in a yearly activity report prepared in the course of last 60 days in the year concerned. It spells out the details of clients administered by the licensee in the state within the period. The specific information includes the names and addresses of the clients, together with the kind of service administered. All these are embodied in a letter that bears the company name dated accordingly.

The administrative incense shall be deemed to operate for a period of not more than 12 months. This starts immediately upon renewal. In many states, the reinstatement entails filing and submitting the following documents; an application form, bond continuation form, certificate of TPA licensing in home state, a list showing names and the address of individuals permitted to act at as agents. In case of any administrative action against you by any state, it is required that you append a copy of the same application.

Where required to prove third party licensure when home state has no certification, just mention the state and provide evidence that it is in fact licensed there. Bond continuation certifies bond renewal. It is necessary to renew bond before applying for reinstatement. In case of changes in bond, evidence the change by attaching a copy.

Every applicant is required to pay a renewal fee. The fee, currently stands at 100 dollars per license. In filing the application form, provide the information accurately and honestly. Other than this, there is need for clarifying the third administrator party status. Also, ensure to fill all the relevant fields and provide the name and contact of a resource person that can clarify any inquiries when necessary. It is always important to retain a copy of the same for future reference and follow up.




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