TPA Dispatch and Review Guide

Who does what

• Dispatch — an Admin or Manager — receives the carrier's assignment, creates the file, assigns it to a person in the network, and reassigns it if that person declines or cannot complete it
• The assigned professional — a partner company, a 1099 contractor, or an employee — accepts or declines the assignment, performs the work, and submits it for review
• The Reviewer / Quality Assurance Analyst checks the submission against the client's standard and either accepts it or sends it back with revision requests. The review role does not assign or reassign work; that stays with dispatch
• Billing approval confirms the work is complete and the fee is authorized before anything goes to the client

The stages, in order

Every dispatched file moves through the same eight stages. The name of the stage should describe exactly where the file is and who is responsible for moving it.

1. 01Dispatched — the file has been assigned to a named professional, with the instructions and claim details attached, and is waiting on their response
2. 02Accepted — the assigned professional has accepted the assignment and now holds the file
3. 03In progress — the work is being done: contact, inspection, documentation, estimate
4. 04Submitted for review — the assigned professional has submitted the work and the file is with the Reviewer / Quality Assurance Analyst
5. 05Reviewed — sent back for revisions — the reviewer has requested changes, and the file has moved back to the assigned professional with the requests attached
6. 06Review accepted — the reviewer has approved the submission
7. 07Sent for billing approval — the completed work is with whoever authorizes the fee
8. 08Sent to client — the deliverable has gone to the carrier, and the file is at the end of its dispatch workflow

Stage 1 — Dispatched

The quality of what comes back is decided mostly at dispatch. An assignment that leaves without instructions returns as questions.

• The carrier's assignment attached to the file in full, with the carrier's reference and every stated deadline entered as a dated task
• Written instructions to the assigned professional: what is expected back, in what format, by when
• The claim, insured, property, and loss details on the file, so the assigned professional is not asking for them
• The assignment sent to one named professional, with the date sent, and a response deadline for acceptance
• A plan for silence — if the assignment is not accepted within the response window, dispatch reassigns it rather than waiting

Stages 2 and 3 — Accepted and In progress

• Acceptance or decline recorded with the date, so the acceptance history is on the file and visible to everyone on it
• A decline followed by reassignment from dispatch, with the reason recorded — declines are information about the network
• The assigned professional's contact attempts, inspection date, and documentation captured on the file as they happen, not at submission
• The file's status changed by the person who changed the fact — the assigned professional marks the file in progress when the work begins
• The carrier's deadlines visible to the assigned professional, so the firm's commitments are theirs too

Stage 4 and 5 — Submitted for review, and sent back

Review is where the firm's standard is applied. It only works if the reviewer can see the whole submission, can state specifically what is wrong, and can send the file back without losing it.

• The submission as a complete package: report, estimate, photographs, and the documents the assigned professional has chosen to publish to the file
• The reviewer's decision recorded on the file — accepted, or sent back — with the date
• Revision requests that name the item and the change: which photograph is missing, which line item is unsupported, which section does not meet the client's format
• The file moved back to the assigned professional with the requests attached, and the status showing that it has moved backward
• Resubmission handled as a new pass through review, with the earlier review decision still on the file
• The reviewer approving or requesting revisions only — if the file needs a different professional, that is a reassignment, and it goes back to dispatch

Stages 6 through 8 — Review accepted, billing approval, sent to client

• Review accepted recorded with the date, so the time from submission to acceptance is measurable per file and per professional
• The fee for the assigned professional reconciled against what was dispatched and what was actually authorized, before billing approval
• The deliverable sent to the carrier in the carrier's required format, with proof and date of delivery
• The assigned professional's payment tracked to receipt, separately from the carrier's payment to the firm
• Supplements and re-inspections handled on the same file, re-entering at Dispatched or Accepted so the history stays continuous

Who sees what on a dispatched file

A network file is shared by design. The firm, the reviewer, and the assigned professional are all working the same record, and most of it should be visible to all of them. Two things are not, and one is the assigned professional's to decide.

• Visible to every party on the file: the assignment and its instructions; claim, insured, property, and loss details; file status and workflow position; the acceptance, decline, and reassignment history; and every submission, review decision, and revision request
• Private to the assigned professional: the photos they capture and their email correspondence on the file
• Decided per document: each document the assigned professional uploads carries its own visibility switch — published to the network, or kept private. It is not all-or-nothing
• Outside the pool entirely: an assigned professional's own clients and claim files, the work they bring in outside the network, are not part of the firm's records

Where dispatch files stall

• An assignment sent to a mailbox and never formally accepted, so nobody knows whether it is being worked
• Instructions given by phone and not on the file, so the submission meets a standard the assigned professional never saw
• A revision request that says 'fix the report' rather than naming the item
• A file sent back for revisions that nobody is tracking, because backward movement is not a status anyone watches
• A review decision made in an email thread, invisible on the file
• Billing approval waiting on a fee reconciliation that was never started at dispatch

What good looks like

• Every dispatched file has a named assigned professional, a status, and the date the status last changed
• Dispatch can list every file waiting on acceptance, every file in review, and every file sent back, without asking anyone
• The assigned professional can see what is expected and what has been requested without a phone call
• The reviewer sees the complete submission and records the decision on the file
• The carrier receives one deliverable, in its format, on its date, and never sees the review loop behind it