Month: April 2025

Solving the Top 3 Challenges Facing TPAs — How HealthAxis Empowers Modern Administration

The role of a third-party administrator (TPA) has never been more complex—or more critical. The global insurance third-party administrator market size was valued at $324.9 billion in 2022 and is projected to reach $795.1 billion by 2032¹. This expansion is fueled by the rising demand for specialized services, the increasing complexity of insurance regulations, and the ongoing need for greater operational efficiency and transparency within the industry. 

TPAs sit at the heart of the healthcare ecosystem, serving as the connective tissue between payers, providers, and members. But today’s healthcare landscape is evolving rapidly, and TPAs are under increasing pressure to deliver more value with fewer resources. From navigating fragmented systems to meeting rising member expectations, the challenges are real—and growing. 

At HealthAxis, we’ve spent decades partnering with TPAs, understanding their pain points, and developing smart, scalable solutions like AxisCore and AxisConnect. AxisCore is a next-generation platform purpose-built to help TPAs thrive in a new era of healthcare administration. AxisConnect is our comprehensive suite of business process outsourcing (BPO) and business process as a service (BPaaS) capabilities.  

Here, we break down the top three challenges TPAs face today—and how HealthAxis solutions can help turn them into opportunities. 

Challenge #1: Fragmented Systems and Inefficient Workflows 

The Problem:
TPAs are often stuck working across multiple legacy platforms for claims, eligibility, billing, reporting, and member engagement. These siloed systems lead to redundant processes, manual errors, and limited visibility—slowing down operations and increasing costs. 

The Solution: A Seamless Center with AxisCore + AxisConnect
AxisCore is a unified platform that brings together the full spectrum of TPA functionality—claims, enrollment, provider management, customer service, and reporting—into a single, powerful environment. With real-time data sharing, automated workflows, and centralized access, TPAs gain: 

  • Faster, more accurate claims processing 
  • Integrated provider and member management 
  • Fewer manual touchpoints and errors 
  • Simplified reporting and audit readiness 

AxisCore takes integration even further. It bridges external systems and data sources—including clearinghouses, EHRs, and client portals—ensuring interoperability without disruption. Whether you’re onboarding a new client or syncing with a health system, ensuring your systems talk to each other—seamlessly. 

AxisConnect offers experienced teams to handle admin tasks with precision—so you can focus on scaling your operations without the immediate overhead.  

Challenge #2: Staffing Constraints and Operational Scalability 

The Problem:
Running a TPA operation is resource intensive. Hiring, training, and retaining skilled teams for every aspect of claims and customer service is costly and time-consuming—especially when trying to scale or take on new business. 

The Solution: On-Demand Support with HealthAxis BPO + BPaaS
Our Business Process Outsourcing (BPO) services allow TPAs to offload high-volume, repetitive tasks like claims entry, eligibility verification, and call center operations to our expert team. We operate as an extension of your organization—reducing overhead while maintaining quality. 

With BPaaS, we go a step further by offering both the technology and the operations bundled into a scalable, turnkey service. TPAs can launch or expand business lines without having to invest in internal teams or infrastructure. Benefits include: 

  • Reduced administrative costs 
  • Faster speed-to-market 
  • Scalable operations that flex with demand 
  • Dedicated teams with deep healthcare expertise 

Whether you need full outsourcing or just overflow support, we help you focus on strategy while we handle the execution. 

Challenge #3: Increasing Member and Client Expectations 

The Problem:
Today’s members expect the same level of service from their health plan as they do from their favorite consumer brands—real-time information, easy digital access, and proactive communication. Employers and payers expect transparency, customization, and performance metrics on demand. Meeting these expectations with outdated tools just doesn’t cut it. 

The Solution: Personalized, Digital-First Experiences with AxisCore + AxisConnect
With AxisCore’s intuitive member and provider portals, TPAs can deliver modern, self-service experiences that drive satisfaction and retention. Members can: 

  • Access ID cards, claims, and benefits anytime 
  • Receive real-time notifications and updates 
  • Submit inquiries and track resolutions 
  • Employers and payers get dashboards, reports, and insights tailored to their needs. 

Our platform also enables TPAs to integrate with wellness programs, telehealth platforms, and analytics tools to further personalize the experience. 

And when it comes to live support, our AxisConnect BPO teams provide responsive, HIPAA-compliant member and provider services on your behalf. Whether through phone, chat, or email, we meet people where they are—with empathy, speed, and professionalism. 

 

The HealthAxis Advantage: A Modern Model for Modern TPAs 

At HealthAxis, we don’t believe in one-size-fits-all. We believe TPAs deserve the right mix of technology, automation, and operational support tailored to their goals. 

By combining: 

  • AxisCore for powerful, integrated administration 
  • AxisConnect for flexible, expert operations 

…we help TPAs lower costs, improve outcomes, and deliver exceptional service—without compromise. 

Whether you’re looking to modernize your core systems, reduce operational load, or scale into new markets, HealthAxis has the infrastructure and expertise to get you there. 

Ready to take your TPA operations to the next level? Schedule a demo today and discover how HealthAxis can transform your operations and drive long-term success. 

 

Sources:  

¹Insurance Third Party Administrator Market Size, Share, Competitive Landscape and Trend Analysis Report by Service Type, End User, Enterprise Size: Global Opportunity Analysis and Industry Forecast, 2023-2032, Allied Market Research 

Interoperability and Prior Authorization: A 2027 Perspective

The healthcare industry has long recognized the inefficiencies of prior authorization (PA) processes, which have historically been plagued by delays, administrative burdens, and provider frustration. However, as we look ahead to 2027, mandated interoperability advancements offer a promising solution. The question is: will providers adopt it immediately? And what can payers do now to ensure a seamless transition? 

Will Providers Use Interoperability for Prior Authorization? 

The short answer: It depends. While interoperability solutions offer the potential to streamline prior authorization, providers will ultimately adopt them only if they perceive a clear value. This means the process must be faster, easier, and less burdensome than current methods. Adoption will hinge on usability, integration within existing EHR/EMR systems, and tangible benefits such as reduced administrative effort and improved patient outcomes. 

Barriers to Provider Adoption 

Despite the promise of interoperability, providers face several barriers to adoption: 

  • EHR/EMR Access & Integration: Many providers rely on legacy systems that may not be ready to seamlessly integrate with new prior authorization APIs. 
  • Technology Gaps: Smaller practices and independent providers may lack the IT resources to implement and maintain these solutions effectively. 
  • Cost Considerations: Even if the technology is available, providers will weigh implementation costs against potential time savings and reimbursement improvements. 
  • Training & Workflow Disruptions: Any change requires training and workflow adjustments, and busy healthcare providers may be resistant to temporary inefficiencies. 

Payers Must Engage Providers Now 

Rather than waiting for interoperability mandates to take full effect in 2027, payers should proactively engage with their provider networks today. By initiating discussions now, payers can: 

  • Gauge provider interest and readiness for API-based prior authorization. 
  • Identify key barriers and strategize ways to overcome them—whether through funding support, training, or technology partnerships. 
  • Build trust and collaboration, ensuring a smoother transition when interoperability solutions become widely available. 

Payers and providers share the common goal of improving patient outcomes – and taking every opportunity to collaborate on solutions and future opportunities also enables building strategic relationships to solve other challenges, such as enabling value-based care. 

How Early Engagement Benefits Payers 

In 2026, payers will be required to publicly report prior authorization data, including approval rates and turnaround times. This increased transparency will put pressure on payers to improve performance and demonstrate efficiency. By starting the conversation with providers now, payers can: 

  • Reduce friction in the transition to interoperability, ensuring faster adoption in 2027. 
  • Improve authorization processing times, which will reflect positively in public reporting. 
  • Differentiate themselves in the market by offering providers a more seamless, value-driven experience. 

The Road to 2027 

The shift to interoperable prior authorization is not just a regulatory mandate—it’s an opportunity to improve healthcare administration and patient care. However, successful implementation will require a deeper collaboration between payers and providers. By acting now, payers can pave the way for a more efficient, transparent, and provider-friendly future. 

HealthAxis remains committed to supporting our partners in this transition. The time to prepare is now—let’s build a smarter, more connected healthcare ecosystem together. Schedule a demo today to learn more.  

Author:

Norah Brennan,

Vice President of Product Management