Tag: third-party administrators
Payer relations: Have a game plan
May 13, 2026Cadie McGonagill
Q. What can we do about a payment system that's failing DME suppliers?
A. Intermediaries and third-party administrators (TPAs) have become significant players in how durable medical equipment reaches patients. For DME businesses serving everyday communities, the burden is becoming difficult to sustain.
As the prevalence of TPAs supporting Medicaid Managed Care and Medicare Advantage payers trends upward, our industry needs a game plan to respond to an evolving model that, without proper...
Payers move deeper into TPA model, according to poll
May 1, 2026Theresa Flaherty, Managing Editor
YARMOUTH, Maine – The accelerating shift to third‑party administrators (TPAs) appears to be gaining steam: Ninety‑two percent of respondents to a recent HME Newspoll say payers are already using or transitioning to this model, and most of the rest expect it within a year.
“I think this has the potential to be very disruptive and negative for small DMEs,” wrote one respondent. “The TPAs don’t seem interested in engaging suppliers of our size that have a personal...
AMA recommends oversight of TPAs
November 16, 2022HME News Staff
HONOLULU – The American Medical Association decided at its interim meeting here to recommend that third-party administrators of specialty pharmacy benefits be included in state and federal oversight efforts of prescription drug middlemen. Regulation of pharmacy benefit managers is on the rise in response to concerns that they can have a detrimental impact on the ability of patients to access affordable prescription drugs and, for specialty pharmacy benefits, TPAs provide many of the same services,...
Providers struggle with TPAs
November 15, 2019Liz Beaulieu, Editor
YARMOUTH, Maine - The resurgence of third-party administrators for HME is bad news for the industry, according to the large majority of respondents to a recent HME Newspoll.TPAs are unnecessary middlemen between insurers and providers, further complicating an already complex system, respondents say.“We don't need another level of bureaucracy that has to be paid by somebody, typically the provider in the long run,” wrote one respondent.Eighty-six percent of respondents report currently...