You have assumed the responsibilities of another TPA. While auditing the files you discover that there are missing indemnity files. You should:

You have assumed the responsibilities of another TPA. While auditing the files you discover that there are missing indemnity files. You should:

• A. Contact Self Insurance Plans and ask for assistance
• B. Contact the prior administrator and inform the ER
• C. Contact the Administrative Director and request an audit
• D. Contact the I&A office and ask for assistance

Answer: (B)

When you take over as the new TPA and notice missing indemnity files, the immediate priority is to recover those records and keep the employer in the loop. Reaching out to the prior administrator is the right first step because they are the ones who handled the files previously and will know where any missing documents are or why they’re unavailable. Informing the employer about the gap ensures transparency, preserves accountability, and allows the employer to participate in resolving the lapse and any regulatory or contractual implications. This approach also helps establish a proper audit trail for the transition, so future audits or reviews can verify that the missing records are accounted for and that any necessary remediation steps are taken. Other routes, like escalating to Self Insurance Plans, requesting an audit from the Administrative Director, or contacting the I&A office, are appropriate for broader oversight or escalation, but they don’t directly address the immediate need to locate missing indemnity files or keep the employer informed.

When you take over as the new TPA and notice missing indemnity files, the immediate priority is to recover those records and keep the employer in the loop. Reaching out to the prior administrator is the right first step because they are the ones who handled the files previously and will know where any missing documents are or why they’re unavailable. Informing the employer about the gap ensures transparency, preserves accountability, and allows the employer to participate in resolving the lapse and any regulatory or contractual implications.

This approach also helps establish a proper audit trail for the transition, so future audits or reviews can verify that the missing records are accounted for and that any necessary remediation steps are taken. Other routes, like escalating to Self Insurance Plans, requesting an audit from the Administrative Director, or contacting the I&A office, are appropriate for broader oversight or escalation, but they don’t directly address the immediate need to locate missing indemnity files or keep the employer informed.