Closing the Gap: How TPAs can Command Claims and Control Costs

October 28, 2025 Key Takeaways from the Texas Association of Benefit Administrators Conference

The recent Texas Association of Benefit Administrators (TABA) Conference in Dallas offered more than just networking. It was a wake-up call for third-party administrators (TPAs) navigating today's complex healthcare claims environment — one where rising costs, regulatory pressures, and the growing burden of Independent Dispute Resolution (IDR) are reshaping expectations for claim performance.

Conversations on the floor were focused and the challenge was clear: managing claims isn't enough anymore. TPAs must command them in order to control costs.

Key Trends Emerging from TABA

• TPAs are re-evaluating partners based on results, not promises.
• Out-of-network negotiations and DRG validation are top priorities.
• There's rising demand for faster turnarounds and transparent pricing strategies.
• IDR disputes are on the rise, driving administrative costs and legal exposure.
• Everyone's asking: Where else are we leaving money on the table?

The Hidden Cost of IDR Challenges

While the No Surprises Act aimed to protect patients, it has created new complexities for TPAs and payors. IDR cases are costly, slow, and unpredictable, often resulting in inflated provider awards and prolonged payment cycles. Many payors are learning that avoiding IDR altogether — through proactive, fair, attorney-led negotiations — is far more effective than fighting battles after the fact.

At H.H.C. Group, we help TPAs stay ahead of these challenges by achieving defensible settlements before claims escalate. Our approach minimizes disputes, strengthens compliance, and preserves relationships between payors and providers.

Here is where H.H.C. Group sets itself apart:

• Attorney-Led Claim Negotiation: Slash large-dollar claims by up to 90%, even with PE-backed providers.
• Access to Major Preferred Provider Networks: Leverage existing agreements to maximize savings on claims down to $1.
• Independent Reviews/Utilization Reviews: Maintain plan integrity with unbiased medical necessity reviews by board-certified specialists — trusted by payors to validate care and support defensible decisions.
• Reference-Based Pricing: Anchor payments to fair, transparent benchmarks — not inflated fee structures.
• Fast Turnaround: Most claims resolved in 5–7 business days to keep you ahead of aggressive billing tactics.
• 30 Years of Proven Results: With a proven 30-year track record of successfully negotiating both in- and out-of-network facility claims, H.H.C. Group remains a trusted partner for cost containment nationwide.

The TABA Conference highlighted a growing disconnect between what many TPAs accept and what they could actually save. H.H.C. Group is committed to closing this gap by bringing speed, strategy and accountability to every claim, every time.

Contact HHC Group today to learn more about how we turn conversations into measurable savings and help strengthen claims strategies worldwide.

Real People. Real Savings. Real Strategy.