The Importance Of TPA License Renewal Compliance

By Eloise Hewitt


Currently, about forty four states have a requirement for third party licensing. Many companies consider state licensing and renewal regulations as complex. They hence opt for consulting services in order to obtain their licenses rather fast and efficient. Some states, particularly those without a TPA licensing requirement, have corporate adjuster compliance. Although there are similarities, each states TPA license renewal compliance is different.

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 commissioner of commerce is the ultimate assessor as to who is eligible for the registration. The commissioner, upon application, satisfies whether the administrator is able to offer deliver third party administration or not. This is particularly based on the financial position of the administrator, that is, should be solved. The ability to process claims in timely and equitably is also a vital factor.

On application, the administrator must ensure that the report, compliance has been adhered to in all the previous years. During registration, the applicant is always required to file reports by itself or see to it that the clients served file the same. The reports are actually the services that the administrator is provided within the time stipulated by the statute, the rule or an order from the commissioner.

The required reports are embodied in an annual activity report that is filed within the last sixty days of the year. The report states the name and physical address of the clients that the licensee administered in the state during the previous year. Also, the area and the type of service performed to each plan and the commencing and termination dates each client was served. It is presented in the form of a letter bearing the company name and date on it.

As a general rule, the administrator license shall continue in operation no longer 12 months commencing the very month of issuance. The renewal application must include, but not limited, to the following documents; a completed renewal application form, bond continuation certificate, proof of TPA license in home state, a list detailing the names and addresses of people the administrator has contracted within the law and a copy of any administrative action, if any, from any state.

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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