Negotiating Third-Party Administrator Agreements for Health Plans: Essential Provisions and Strategic Considerations

Trucker Huss

As health care costs continue to rise, an increasing number of employers are transitioning to self-funded health plans.  Successfully negotiating the terms of a third-party administrator (TPA) agreement is essential—both for cost containment and for ensuring appropriate legal protections. In this session, Mary Powell and Sarah Kanter will examine key contractual provisions and offer practical guidance on the following topics:

• The Independent Dispute Resolution (IDR) process and its impact on plan costs, including contractual strategies for mitigation
• “Shared Savings” fee arrangements: understanding the mechanics and limiting exposure
• Identifying and addressing ancillary fees, including prepayment integrity fees and overpayment recovery charges
• Medical rebate provisions: ensuring proper allocation and transparency in TPA reporting
• Performance guarantees: evaluating whether metrics are meaningful
• Additional critical provisions, including artificial intelligence safeguards, data access rights, limitation of liability, and indemnification clauses

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