Consideration for new TPA contracting is contingent upon timely submission of a TPA Questionnaire to NCPPO and HealthLink’s Payor Relations Department. Such TPA Questionnaire is available from NCPPO and HealthLink’s Payor Relations Department. Please contact NCPPO and HealthLink at PayorRelations@HealthLink.com or 1-877-284-0101 ext 6132. Completion of the TPA Questionnaire is not a guarantee of a working relationship.

Requirements of a new TPA include the following:

1. Roll a minimum of 500 new member lives upon implementation, or pay a set up fee of $2,500 if less than 500 members and meets remainder of requirements.
2. Compliance with HIPAA Standard Transactions (including the 997 Acknowledgement).
3. Compliance with NCPPO and HealthLink’s ID card standards.
4. Compliance with NCPPO and HealthLink’s EOB standards.
5. Compliance with NCPPO and HealthLink’s electronic Eligibility standards.
6. Compliance with NCPPO and HealthLink’s Provider InfoSource requirements.
7. Maintain a minimum 10% benefit differential between the PPO and out-of-network benefit tiers.
8. Sign a TPA Agreement and require each of their client groups to sign the required (TPA) Payor Agreement with HealthLink.

If all requirements cannot be met, please contact NCPPO and HealthLink’s Sales/Marketing division at 1-800-235-0306 for further discussion and/or consideration.