Direct Contract Administration
H2B’s role as a Direct Contract Administrator is to reprice claims associated with the direct contracts and deliver them to the TPA ready for plan adjudication.
By assuming the front end of the administrative load associated with direct contracts, we address the friction that often deters providers from participating, while focusing on the details that typically fall outside of TPA core competencies. Managing the TIN, NPI, provider roster and directory, and schedule information, housing the data, and subsequently passing “ready-to-adjudicate” claims to TPAs streamlines the process and ensures the successful maintenance of the contract provisions.
H2B’s independent and agnostic infrastructure solutions are a new vendor class known as Direct Contract Administration (DCA). We are not affiliated with or owned by another company. Our unbiased DCA vendor class enables H2B to partner collaboratively with all interested employers, benefit consultants/advisors/brokers, third-party administrators (TPAs), repricers and other vendors, health systems, and providers in the self-funded or level-funded space. H2B is not an insurance carrier, TPA, benefit consultant, broker, or broker to the broker (general agency (GA) or managing general agent (MGA)).