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Registration Information For Third-Party Administrators (TPA)

Registering with the State of Vermont - To be completed annually by December 31st.

See GMCB Rule 8.000: Data Submission for more information about registration and reporting requirements.

Register here: Onpoint Claims Data Manager.

Under Vermont laws and regulations, a Third-Party Administrator (TPA) is defined as any person who, on behalf of a health insurer or purchaser of health benefits, receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of this State or Vermont health care providers and facilities. This includes an entity conducting administrative services for business or possessing claims data, eligibility data, provider files, and other information relating to health care provided to Vermont residents or by Vermont health care providers or facilities. All TPAs serving Vermont residents are required to register on an annual basis—by December 31st—with the State of Vermont. Agencies serving 200 or more Vermont resident members must also report claims in Vermont’s All-Payer Claims Database (APCD), called Vermont Health Care Uniform Reporting and Evaluation system, or VHCURES. Currently both annual registration and VHCURES reporting occurs via Onpoint Health Data, GMCB’s contractor for VHCURES data collection, consolidation, and user support. If you are experiencing problems with the registration or need further information about the process, please contact Onpoint Health Data Systems at vt-support@onpointhealthdata.org or by phone at 207-623-2555. General questions or inquiries related to VHCURES stewardship and governance can be sent to GMCB at gmcb.data@vermont.gov.

Effective July 1, 2022

Third Party Administrators of life, annuity, health, or stop-loss coverage, including tax-advantaged accounts for health-related expenses must apply for a Third Party Administrator License. Click here to read the Third Party Administrator Rule, Reg. I-2021-01. Entities administering other lines, including property and casualty, accident and sickness, long term care, or workers’ compensation are not required to get licensed. This is an new added requirement by the State of Vermont. TPAs still need to register with the Green Mountain Care Board by December 31st of each year as described above. For entities that are not required to be licensed as a TPA under the Rule, registration with the Green Mountain Care Board satisfies the annual registration requirement in Section 14. Click here for the TPA licensing application.