TPA Programs: the keep, drop, or renegotiate read

What this article covers

A TPA (third-party administrator) program is a deal: you get routed work in exchange for a fee, a price-list discount, or both, plus whatever turnaround and documentation requirements the program sets. That deal is easy to accept and hard to keep evaluating once the jobs start flowing. This article covers the two surfaces Verinode gives you for weighing it honestly:

1. The TPA Programs tab, an economics table that pairs each program's fee against the volume it actually routes, how slowly it pays, and the receivables it ties up.
2. The Program Rate section inside an individual TPA's own detail card, where you log the exact rate you've accepted and see it against the anonymized cohort of operators on the same program.

Verinode does not negotiate on your behalf and does not tell you which programs to keep. It reads the jobs and invoices already on file, and once you tell it your rate, shows you where you sit. You decide whether to keep the program, push back on the terms, or step away from it.

Where to find it

Open Clients from the sidebar at iq.verinode.ai/clients. On the Clients home page, the Explore row includes a TPA Programs tile: it shows the count of programs you're on and, once volume is on file, how much has routed through them in the last 12 months (for example, "$412.0k routed"). Before any TPA volume has billed, the tile reads "TPA fees appear as invoices land" instead. A small bar preview behind the tile shows relative 12-month volume across your programs.

Tap the tile and it opens the full-screen client overlay directly on the TPA Programs tab, one of nine tabs across the top (Findings, Book of Business, All Clients, Health, Pushback, Scorecards, Carrier Programs, TPA Programs, Benchmarks). The economics table described below lives there.

The second surface, program-rate transparency, lives one level deeper: open any individual TPA's own detail card (tap its row on the All Clients or Health tab, or from anywhere its name appears as a link), then open the Pushback tab on that card. The Program Rate section sits near the top of Pushback, above the denial-rate figures, because a program's fee and a program's denial pattern are two different reasons to keep, renegotiate, or drop it, and Verinode keeps them next to each other rather than burying one.

The TPA Programs economics table

What it is. One row per TPA program you're enrolled in (archived programs are excluded). Each row pairs the program's fee with what it actually delivered over the trailing 12 months, so you can weigh cost against deal flow instead of judging a program on the fee percentage alone. This is the same math Verinode's own reasoning reads when it flags a program worth a second look, so the number on this table and any finding that references it will always agree.

A short line above the table sets the frame: "What each program costs against the work it brings. Weigh the fee and how slowly it pays against the deal flow before you keep, renegotiate, or step back." A count reads "N programs" (or "1 program") to the right of the heading.

The columns, left to right:

• Program, the program's name as recorded on file. If a program has no name on file, the row reads "Unnamed program."
• 12-mo volume, the total billed dollars on jobs tied to this program over the trailing 12 months. Reads as a dash when there's no billed volume in that window yet.
• Avg days to pay, the average days-to-pay across jobs on this program that have a recorded pay date. A dash means no jobs on this program have a recorded days-to-pay yet.
• Fee, the program's fee as recorded: a percentage (for percentage-based fee types) or a dollar amount (for flat fee types). Reads "Not on file" when no fee has been captured for the program.
• Est. annual fee, only calculated when the fee is a percentage: it's the fee percentage applied to the 12-month volume, so a 10% fee on $200k of trailing volume reads as roughly $20.0k. For flat or other fee types, this column is a dash, the fee is stated but Verinode doesn't extrapolate an annual estimate from a per-job or per-transaction fee without knowing transaction count.
• Outstanding, the dollars currently billed and unpaid on jobs tied to this program. A dash means nothing is outstanding on this program right now.

Rows are sorted by 12-month volume, largest first, so the programs actually driving your business surface at the top regardless of how loud their fee is.

How to read it. A program with a high fee and low volume is a candidate to drop or renegotiate, you're paying for access that isn't delivering much work. A program with a high fee, strong volume, but slow days-to-pay and heavy outstanding dollars is a different conversation: the work is real, but the cash conversion is costing you, which is a case for negotiating payment terms rather than walking away from the volume. A program with a modest fee, strong volume, and fast payment is the one worth protecting if a renewal or requirement change comes up.

Empty state. If you have no TPA jobs or invoices on file at all, this surface renders nothing, there's no "TPA Programs" tile on the Clients home page until at least one program has fee data or billed volume to show. Once you have programs on file but nothing has billed yet in the last 12 months, the table renders your programs with dashes in the volume, days-to-pay, and outstanding columns until jobs bill.

Program Rate: your rate vs the anonymized cohort

This is the second surface, and it lives inside one TPA's own detail card, in the Pushback tab, above the denial-rate figures. It answers a narrower and sharper question than the economics table: on this specific program, is the rate you've accepted in line with what other operators on the same program are paying, or are you leaving margin on the table.

A short line frames it: "The rate you accept on [TPA name], and how it sits against the anonymized cohort of operators on the same program. Peers are never named."

Rate types you can log. Four kinds of terms, matched to how TPA programs are typically structured:

• Discount off price list, a percentage discount off a price list (most commonly Xactimate, sometimes Symbility or a custom list). This is the most common TPA term.
• Admin fee, a percentage administrative fee.
• Referral fee, a percentage referral fee.
• Flat fee per job, a fixed dollar amount charged per job rather than a percentage.

Each rate row is labeled by its kind, and for a price-list discount, its basis is appended only when it isn't the default: "Discount off price list (Symbility)" or "Discount off price list (Custom price list)." A plain Xactimate-basis row just reads "Discount off price list," since Xactimate is the basis on nearly every program and naming it every time is noise.

What each rate row shows. Your own value is always shown, full stop, it's your data and it's never gated or blurred. Beside it, when a comparable cohort exists, a peer figure and the gap between your rate and that cohort: how many percentage points (or how many dollars, for a flat fee) you sit above or below it, visualized as a small bar with your value and the cohort figure marked on it. For every rate kind, lower is treated as better for you, a smaller discount given off your price list or a smaller fee is better margin, so the comparison colors your position accordingly rather than assuming "more" is good.

Under a row with a peer figure, a caption names the size of the cohort behind it in plain terms (how many operators are contributing to that comparison on this program), whether it's an early signal still forming, and the program name if one was captured with the rate.

Why a peer figure might not show. The cohort comparison only resolves once enough operators have logged a comparable rate (same TPA, same rate kind, same price-list basis where relevant) for the value to be shared safely. Peer data is never a single other operator's number, and it's never attributable, individual operators are never named or identifiable from it. Until enough contribute, your own rate still shows, just without a comparison line beneath it. This is standard across every peer benchmark in Verinode: your data is never withheld, the network's aggregate view is what has to earn its way to a publishable number.

Adding a rate. Tap Add your program rate (or Add another rate once you've logged at least one). A form opens with:

• Rate type, a segmented control across the four kinds above.
• Price-list basis, only shown when Rate type is "Discount off price list": Xactimate, Symbility, or Custom.
• Rate (%) or Amount ($), depending on the rate type, a number field with a placeholder example (e.g. "e.g. 10" for a percentage, "e.g. 150" for a flat fee).
• Program (optional), a free-text field for the specific program name if this TPA runs more than one (e.g. "Water panel").

Hit Save rate to submit, or Cancel to back out without saving. Entering a value that isn't a valid non-negative number is rejected with "Enter a valid rate." before it saves. On success you'll see a confirmation toast, "Program rate saved," and the row appears immediately, no reload needed. There's no limit on how many rates you log per TPA, each rate type and program name combination is tracked as its own entry, so if a TPA runs a water program and a fire program with different terms, log each separately.

Empty state. Before you've logged anything: "No program rate on file for [TPA name] yet. Add what you're paying so you can see whether you sit above or below the cohort."

When this section doesn't appear at all. The Program Rate section only renders for TPA-type clients, it's absent on carrier, private-pay, and commercial detail cards. It's also gated behind whether program-rate transparency is turned on for your account; while it's off, the section simply doesn't render, own-value entry included.

How to use both surfaces together

Start on the TPA Programs tab and sort by what jumps out: a high fee against thin volume, or strong volume dragged down by slow payment and heavy outstanding dollars. Pick the program that looks worst on that read, then open that specific TPA's detail card and check its Program Rate section. If your rate sits meaningfully above the cohort on the same program, you have a concrete number to bring into a renegotiation conversation, not just a feeling that the fee is too high. If your rate is already at or below the cohort and the program is still costing you, the problem is more likely deal flow or payment speed than the rate itself, and the fix is a different conversation (or a decision to step back from the program).

Best-practice example

Say the TPA Programs table shows a "Water Panel" program with a 10% fee, $180k of 12-month volume, a 52-day average days-to-pay, and $34k outstanding, next to a "Fire Panel" program from a different TPA with a 12% fee, $310k of volume, and a 24-day average days-to-pay. On fee alone, the Fire Panel program looks more expensive. But its volume and payment speed make it the stronger program: it's delivering more work and converting to cash faster. The Water Panel program is the one worth a closer look, open that TPA's card, check the Program Rate section, and if the logged discount-off-price-list rate sits above the cohort on the same program, that's the number to raise when you talk to your TPA contact about either the rate or the payment terms.

Related reading

• Clients and carriers for how the relationship model (carrier, TPA, private-pay, commercial) fits together
• Opening a client: the relationship detail card for the full tab set on an individual client's card, including Pushback, Performance, and Scorecards
• How benchmarks work for how anonymized peer cohorts are built and why some comparisons show an early-signal marker
• Reading a benchmark for how to read a peer comparison bar and delta
• Benchmarks overview for the platform-wide benchmarks surface these programs feed into
• Forwarding documents for the fastest way to get TPA invoices and claim summaries into Verinode so program economics populate

Data sources