What Your TPA Won't Tell You About Its Own Accuracy

A third-party administrator's job is to run split billing accurately against the rules it's configured with. It is not to independently verify that those rules still match your current patient definition policy, your current contract pharmacy footprint, or the latest manufacturer restriction.

What drifts silently

Accumulator and replenishment settings, restriction updates, and reporting cadence all tend to be configured once and revisited rarely. Small misconfigurations compound quietly, showing up as savings that simply never arrived rather than as an obvious error.

What an independent review actually checks

Whether captured claims match what's actually eligible — not just what the platform flags — and whether restriction changes are being tracked and applied as manufacturers update them.