The company that administers workers’-comp claims on behalf of a carrier or a self-insured employer — and, for most nurse case managers, the entity that actually receives the invoice.
A third-party administrator handles claims for an entity that carries its own risk — a self-insured employer — or for a carrier that outsources administration. The adjuster you speak to often works for the TPA rather than for the insurer whose name is on the policy.
The names that recur nationally: Sedgwick, Gallagher Bassett, ESIS, Helmsman, Broadspire, CorVel, TRISTAR, CCMSI, Athens Administrators.
Unlike a state fund, a TPA has no published fee schedule of its own and no single remittance behaviour. Invoice requirements, backup documentation, submission address and payment speed all vary — and they vary per client of the TPA as well as per TPA.
The practical consequences for a case-management practice: keep the rate and the invoice format per payer rather than per practice, age receivables by payer so a slow administrator is visible as a pattern, and keep proof of what was sent and when.
For nurse case managers this is the whole payer landscape, and it is why invoice-based billing works in all fifty states today — there is no state-specific form to wait for.
The nurse case manager page is written to this workflow: activity log, itemised invoice, aging by payer.
Fifteen minutes, your state’s codes on screen — or start the trial and poke around on your own.