Per-franchisee participation and pushback by location on a TPA

What this part of the TPA detail shows

Most of a TPA's detail overlay reads as one network-wide counterparty: one billed figure, one average days-to-pay, one denial rate, all rolled up across every franchisee that routes claims through that TPA. Two sections break that rollup apart into individual rows instead: Per-franchisee participation, which lists every franchisee with a job on file against this TPA, and Pushback by location, which lists every franchisee's own supplement submissions and denials against this same TPA.

Both answer a different question than the headline figures do. The headline figures answer "how is the network doing with this TPA." These two lists answer "which specific franchisees are actually driving that number." That is exactly why they carry more privacy machinery than almost anything else on the TPAs page: a per-franchisee row can identify a single business by elimination if it's shown carelessly. This article documents what each row means, where the numbers come from, and, in detail, why the two lists are gated differently, because they are, and it matters which is which when a section renders empty or anonymized.

Verinode HQ is the network intelligence layer sitting on top of what your franchisees already run day to day. It is not a job-management system, and this overlay is not where you go to manage an individual franchisee's claim. Franchisees own their business data. What HQ sees here is a rollup Verinode builds nightly from that data, filtered through a privacy boundary designed so leadership can see the network's pattern with a TPA without being handed a single franchisee's private book of business. Verinode surfaces the pattern; leadership decides what to do with it.

Where to find it

Open Accounts from the HQ sidebar at hq.verinode.ai/carriers. The page opens on the Carriers pill of a three-pill strip (Carriers · TPAs · Commercial). Click the TPAs pill to land on hq.verinode.ai/tpas. Click any TPA tile, in any row on that page (the Network TPAs hero, Slowest Payers, Broadest Network Footprint, Heaviest Pushback, or All TPAs), and the TPA detail overlay opens as a wide modal on top of the page. Closing it returns you to the same scroll position.

Inside the overlay, scrolling past the slot hero, the four headline KPIs, the two job-volume rows, the network-wide Supplement pushback figures, and the line-item cut breakdown ("What this TPA cuts across your network"), you reach, in order:

1. Pushback by location, the per-franchisee supplement breakdown (only when this TPA has supplement activity on record)
2. Per-franchisee participation, the full per-franchisee job and billing list, at the very bottom of the overlay

A dedicated deep-link route also exists at /franchise/tpas/[canonical_entity_id], useful for a bookmark or a link pasted into an email or report. It carries the headline figures, job-volume tiles, rate terms (when your network has rate transparency turned on), and Per-franchisee participation, but it does not include the network-wide Supplement pushback figures or Pushback by location at all; those two render only in the overlay reached by clicking a TPA tile on the TPAs page itself.

Per-franchisee participation

What it is. One row per franchisee with any job on file against this TPA, sorted by billed dollars (36 months) from highest to lowest.

Reading a row. Each row shows:

• Franchisee name, bold, on the left. Real name or an anonymized label depending on how your network is configured, covered in detail below.
• Meta line underneath the name: the job count over 36 months ("14 jobs (36mo)"), then, only when nonzero, the count from the last 30 days ("· 3 last 30d"), then, only when a completed job exists, the date of the most recent one ("· last Jun 12, 2026").
• Billed, right-aligned: this franchisee's own billed dollars with this TPA over the trailing 36 months.
• Days to pay, right-aligned, hidden on narrow screens: this franchisee's own average days-to-pay with this TPA. Plain text, no color coding here, unlike the red/yellow/green tone the same figure carries in the overlay's top KPI band.
• Fee, right-aligned, hidden below tablet width: this franchisee's own average administration fee with this TPA. Just the dollar amount, no fee-type label on the row itself (the fee type this TPA typically charges shows once, at the network level, in the KPI band above).

Empty state. When no franchisee has a job on file with this TPA yet, the list is replaced with one line:

"No franchisee jobs on file with this TPA yet. Rows populate after the nightly aggregator runs."

This is the normal state for a TPA that has just crossed onto the TPAs page for the first time; participation catches up on the next nightly aggregation cycle, no action needed from HQ.

Pushback by location

What it is. Only appears when this TPA has submitted supplement dollars on record at all, and only ever inside the modal overlay (the deep-link route never shows it). One row per franchisee, sorted by cut dollars from highest to lowest, showing that franchisee's own supplement submissions and denials against this specific TPA. This is the row that answers the question the network-wide denial figure higher up in the overlay cannot: is this TPA's cut pattern systematic (most locations get cut) or isolated (one or two locations are getting cut while the rest sail through), which is the difference between a TPA-policy problem and a documentation-coaching problem at a single location.

Reading a row. Each row shows:

• Franchisee name, bold, on the left, subject to the same real-name-versus-anonymized rule as participation, below.
• Meta line: the supplement count ("6 supplements"), then, only when nonzero, the denied count ("· 2 denied").
• Cut, right-aligned: this franchisee's own denied dollars with this TPA.
• Denial rate, right-aligned, hidden on narrow screens: this franchisee's own denial rate as a share of supplement dollars, colored Ember Red once it reaches 30%.

Aggregate-only disclosure. On networks where per-location detail is withheld (covered below), this whole section is replaced with one line instead of any rows:

"Per-location supplement detail is shown only for networks that own their locations' data. Your network sees the aggregate above."

"The aggregate above" is the network-wide Supplement pushback figures higher in the same overlay: denial rate, cut dollars, average response days, and the 30-day trend, all still computed across the whole network regardless of whether this section shows per-location rows. See Supplement pushback on a TPA for what those figures mean.

No section at all. If this TPA has no submitted supplement dollars on record for anyone, neither the per-location rows nor the aggregate-only disclosure appears; the section is simply absent from the overlay.

Why these two lists are gated differently

This is the part worth being precise about, because the two lists sit at different points on HQ's privacy design, and mixing them up leads to the wrong read of what a blank or anonymized row means.

Per-franchisee participation is always shown, with names anonymized where required. As long as the TPA itself has cleared the network-wide cohort floor (below), every franchisee with a job on file appears as its own row. What changes between network types is only the name on that row:

• Networks configured as a single entity (an enterprise operating multiple branches under one legal structure, where "franchisee" really means "our own location") see the real branch name on every row, because there is no separate business to protect.
• Networks of independent franchisees, including franchise networks and association or cooperative networks (the default, and the safer posture for a new group), see a stable anonymized label instead, formatted as "Franchisee #" followed by four characters (for example, "Franchisee #A1B2"), derived from that franchisee's own account so the same franchisee always gets the same label across every TPA and every visit, without revealing which franchisee it actually is.

So on an independent-franchisee network, participation still shows you the full spread, jobs, billed dollars, days-to-pay, fee, per franchisee, you simply cannot tell which named business sits behind "Franchisee #A1B2" without cross-referencing your own operational knowledge.

Pushback by location is either fully shown or fully withheld, with no anonymized middle ground. Single-entity networks get the full named per-location breakdown, same as participation. Independent-franchisee, franchise, and association or cooperative networks get nothing below row level at all, not even anonymized rows, only the aggregate-only disclosure. The reasoning is different from a name-swap: a franchisee's supplement submission and denial pattern with a TPA is closer to that franchisee's own performance record than a simple job count is, and on a network of independently owned locations, that record belongs to the member, not to the network. HQ's privacy design treats it as data the member holds, not data the network aggregates down to a label.

This is exactly the same fork that governs the equivalent lists on a carrier's detail overlay; see Per-franchisee participation and per-location pushback (carriers) if you want the carrier-side mirror of this article.

The cohort floor: when the whole TPA is hidden

Both lists above only render at all once the TPA itself clears a separate, earlier gate: the network-wide cohort floor. A TPA served by too few distinct franchisees is withheld from the entire overlay, participation and pushback by location included, because naming a specific TPA's figures at all would identify the one franchisee behind it by elimination, regardless of whether the rows would have carried real names or anonymized labels.

When a TPA falls below that floor, opening it shows an aggregate-only message instead of any of its metrics, and the participation, pushback, and line-item queries never run:

Aggregate-only view. This TPA is currently served by fewer than 2 franchisees in your network. Per-TPA metrics are suppressed to protect operator privacy.

That is a privacy floor, not a bug. As soon as a second franchisee starts recording claims through that TPA, the gate lifts on its own at the next nightly refresh, no action needed from HQ.

This floor applies only to networks of independent franchisees. Networks configured as a single legal entity operating multiple locations bypass it and see every TPA's row regardless of how many locations serve it, for the same reason they see real names throughout: there is no separate business behind a branch to protect from elimination.

How to use these two lists

1. 1Open a TPA from any row on the TPAs page and scroll to the bottom of the overlay for Per-franchisee participation first. It tells you which franchisees are actually driving that TPA's billed dollars and days-to-pay, rather than reading only the network-wide blend.
2. 2If the TPA has supplement activity, check Pushback by location before deciding whether a TPA's denial rate is a TPA-policy problem or a single-location coaching gap. A cut concentrated in one or two rows is a different conversation than a cut spread evenly across everyone.
3. 3On an independent-franchisee network, use the anonymized labels to spot the pattern (which franchisee, consistently, pays slowest or gets cut hardest) without needing the real name to act: a network-wide policy question or an escalation to the TPA doesn't require knowing which specific business sits behind the label.
4. 4If Pushback by location shows the aggregate-only disclosure instead of rows, don't chase it further inside HQ. That per-location detail belongs to the member; raise it as a conversation with the franchisee directly if it matters, or work from the network-wide aggregate figures still shown higher in the same overlay.
5. 5Treat a TPA that opens straight to the cohort-floor message as a data-completeness or network-size question, not a compliment. It either has no franchisee relationships rolled up yet, or it sits below the cohort floor and simply hasn't crossed it.

Best-practice example

Say a TPA's overlay shows a network-wide denial rate several points above the national industry average for that same TPA. Per-franchisee participation shows five franchisees with jobs on file; Pushback by location shows the cut is concentrated almost entirely in one row, "Franchisee #C7D2," with the other four showing denial rates close to zero. On an independent-franchisee network, that's the signal to stop reading this as "this TPA is unusually aggressive with our network" and start reading it as "one location's submissions to this TPA need a documentation review," a coaching conversation with that specific franchisee (who you or they can identify outside Verinode) rather than a network-wide escalation to the TPA.

Related reading

• Opening a TPA: the detail view and its Verinode Score: the hero, the four headline KPIs, and the deep-link route that these two lists sit underneath
• Supplement pushback on a TPA: the network-wide denial figures that Pushback by location breaks down by franchisee
• What a TPA cuts across your network: line-item pushback: the line-item depth that sits between Pushback by location and Per-franchisee participation in the overlay
• Per-franchisee participation and per-location pushback (carriers): the same two-list pattern, same gating logic, on the payer side instead of the administrator side
• What HQ sees: the network privacy boundary: the aggregates-only rule that governs this pair of lists and every other per-franchisee rollup on HQ
• TPAs in HQ: your network's third-party administrators at a glance: the page these tiles open from
• Network Health: the HQ command home the TPAs page's data feeds into
• HQ compliance: network-wide compliance posture, for when a per-location pattern warrants a standards conversation

Data sources