Navia Healthcare TPA: Intelligent Claims Administration
Claims adjudication, pharmacy benefit management, real-time pre-authorisations, provider network management, and AI-driven cost containment — the TPA service of Navia Assistance, built for insurers and employers across Africa and active today in Libya and Mauritania.
What is International TPA?
Navia Healthcare TPA is the third-party administration service of Navia Assistance — the operational backbone for insurers, HMOs, and self-funded employers. It manages the entire lifecycle of a medical claim: automated adjudication of outpatient and inpatient claims, direct-billing management, patient reimbursement, pharmacy benefit management (PBM), real-time medical pre-authorisations, and provider network management with credentialing and negotiated fee schedules — with zero margin for computational error on deductibles, co-pays, waiting periods, and policy exclusions.
How Navia Delivers This
Onboarding
We configure your policy structure — including custom sub-limits — directly into the adjudication engine, with no waiting for software updates.
Automated Pre-Authorisation
AI parses incoming medical reports, maps them to standard ICD-10/CPT coding, and returns real-time approval or denial remarks to the hospital.
Claims Adjudication
Clean claims are adjudicated near-instantly against your policy terms; our medical officers focus only on complex, edge-case files.
Pharmacy Benefit Management
We monitor dispensing, verify dosage against age and diagnosis, and prevent over-prescription of branded medication where generics are appropriate.
Provider Settlement
Auto-calculated contracts and faster settlement cycles improve provider cash flow — and ensure your members are prioritised.
Reporting
Live utilisation dashboards plus monthly and on-demand analytics, including predictive cost modelling for self-funded schemes.
Who This Is For
What You Get
- Outpatient and inpatient claims adjudication with direct billing
- Pharmacy benefit management (PBM)
- Real-time automated medical pre-authorisations
- Provider network management, credentialing, and fee schedules
- AI-driven cost containment: length-of-stay protocols, fraud and abuse detection (unbundling, upcoding, phantom billing), and real-time deductible and limit enforcement — cutting medical claims costs by up to 60%
- Employer & HR command centre with live dashboards and self-service member enrolment
- Cloud infrastructure with 99.99% uptime and cross-border disaster recovery
- Dedicated account manager
Our Process
RFP & Scope
We agree on scope, SLAs, and reporting format.
Integration
Policy configuration in the claims platform and team onboarding.
Pilot
Supervised pilot period with daily reporting.
Full Operation
Live operation with monthly performance reviews.
Optimisation
Quarterly cost and quality reviews.
Reporting
Structured reporting to your compliance team.
Example Case
A regional insurer moved its medical book to Navia TPA administration. Policy terms — including custom sub-limits and waiting periods — were configured directly into the adjudication engine, and providers were onboarded to automated pre-authorisation.
Outcome
Clean claims began adjudicating near-instantly against policy terms, with the medical team focusing only on complex files. The insurer receives live utilisation dashboards and monthly cost analytics.
Frequently Asked Questions
Explore a TPA Partnership
Download our capabilities overview or contact the partnership team.