Third-party administrators (TPAs) play an increasingly significant role in dental insurance reimbursement. Many practices participate in networks they did not directly contract with due to shared network agreements administered by these organizations.
This page explains what third-party administrators are, how they affect PPO participation, and why they have become so common.
What Is a Third-Party Administrator?
A third-party administrator manages provider networks on behalf of insurance companies. Instead of contracting directly with a carrier, a practice may participate indirectly through a TPA.
Common TPAs include:
Careington
Connection Dental
DHA (Dental Health Alliance)
Why TPAs Are Used
Insurance companies use TPAs to:
Expand network coverage quickly
Reduce administrative burden
Leverage existing provider contracts
For practices, this often means participation occurs without a new direct contract.
How TPAs Affect Reimbursement
TPAs determine:
Which fee schedule applies
Whether pickup is guaranteed (it usually is not)
Whether participation can change without direct notice
Multiple TPAs may apply simultaneously, increasing complexity.
Summary
Third-party administrators are a major driver of shared network complexity. Practices should maintain clear records of all direct and indirect participation to avoid unintended fee changes.
