📚 SI-TPA Financial System - Complete Documentation

The SI-TPA Financial System is a comprehensive Third Party Administrator platform for managing insurance claims, reserves, payments, and financial transactions.

Main Features

• Dashboard: Overview of all financial metrics and recent transactions
• Claims Management: Create and manage insurance claims with detailed tracking
• Reserves: Off-ledger reserve tracking by category (accounts 2020-2070, 2030)
• Payments: Process payments with full audit trail
• Chart of Accounts: Complete double-entry accounting system
• Billing Scenarios: Standardized billing workflows
• Mobile Navigation: Responsive design with hamburger menu for mobile devices
• Enhanced Testing: Collapsible testing guide with expand/collapse functionality

Key Concepts

The system uses a standardized Chart of Accounts designed for TPA operations:

Assets - Receivables

Revenue (Earned by TPA)

Expenses (Vendor Incurred)

The system supports 7 standard billing scenarios used in TPA operations:

Scenario 1: Vendor Bill Only (No Markup)

Scenario 2: Vendor Bill with Markup

Scenario 3: Internal TPA Hourly Work

Scenario 4: Per-Claim Flat Fee

Scenario 5: Reserve-Based Fee

Scenario 6: Indemnity Payment

Scenario 7: Claim Closure

Key Rules

• Vendor expenses (billable) → Cr 50XX, Dr 1100
• Internal services (TPA work, markup, flat fees) → Cr 40XX, Dr 1100
• Pass-through markup → Dr 1100 (A/R), Cr 50XX (expense), Cr 4050 (markup)
• Reserves → Not posted in GL; reduced at billing or claim closure

Reserves are off-ledger planning tools used to estimate financial exposure. They have no GL impact.

Reserve Categories

Important Concepts

Reserve Lifecycle

1. Initial Setup: Set at FNOL based on claim assessment
2. Adjustments: Modified as claim develops
3. Reductions: Automatically reduced when expenses incurred
4. Closure: Zeroed out when claim closes

What Reduces Reserves?

• ✅ Vendor bills (no markup) - Scenario 1
• ✅ Indemnity payments - Scenario 6
• ❌ Vendor bills with markup - Scenario 2
• ❌ Internal time/fees - Scenario 3
• ❌ Flat fees - Scenario 4
• ❌ Reserve-based fees - Scenario 5

New Claim Requirements

When creating a claim, you must allocate reserves directly to specific categories (account numbers 2020-2070, 2030). There is no "unallocated" option or 2010 account.

Steps to Create a Claim

1. Click the "+ New Claim" button in the navigation bar
2. Fill in claim details:
   • Claim Number (auto-generated or custom)
   • Insured Name
   • Carrier Name
   • Date of Loss
   • Description
3. Allocate reserves to specific categories:
   • Enter amounts for each needed category
   • Leave $0 for categories not applicable to this claim
   • At least one category must have a value > $0
4. Click "Create Claim" to save

Payments are processed through the billing scenarios system:

Types of Payments

• Vendor Payments: Use Scenario 1 (no markup) or Scenario 2 (with markup)
• Indemnity Payments: Use Scenario 6 for settlements
• Internal Billing: Use Scenario 3 for hourly work

Payment Process

1. Navigate to Billing Scenarios from the main navigation menu
2. Select the appropriate scenario
3. Enter payment details
4. Review the journal entry preview
5. Process the transaction

Note: All payments create automatic journal entries and update reserves where applicable.

The system supports various billable scenarios:

Types of Billables

• Hourly Services: Internal time tracking at specified rates
• Flat Fees: Per-claim or service-based fixed fees
• Vendor Pass-through: Vendor costs with optional markup
• Reserve-Based Fees: Percentage of reserves utilized

Markup Rules

Invoice Generation

Invoices are automatically generated when billable transactions are processed. They include:

• All billable items for the claim
• Proper revenue categorization
• Payment terms and due dates
• Full transaction audit trail

The Developer tab provides tools for testing and maintenance:

Available Tools

• Test Data Creation: Generate sample claims and transactions
• Data Export/Import: Backup and restore system data
• Diagnostics: Check data integrity and system health
• Clear Data: Reset specific data types for testing

Enhanced Testing Guide

The integrated testing guide includes advanced functionality:

• Collapsible Sections: Each test step can be expanded or collapsed for better organization
• Progress Persistence: Your testing progress is saved and persists across browser sessions
• Expand/Collapse All: Buttons to quickly expand or collapse all test steps
• Step-by-Step Instructions: Detailed guidance with copyable values and expected outcomes
• Impact Documentation: Each step shows both GL impacts and off-ledger reserve impacts
• Account Number Clarity: Reserve accounts properly show their numbers (2020-2070 range)

Testing Scenarios

Use the test pages to verify functionality:

• test-claim-creation.html - Test claim creation flows
• test-payments.html - Test payment processing
• test-reserve-transactions.html - Test reserve movements

All data is stored locally in your browser using localStorage.

Important Points

• Data persists between browser sessions
• Data is specific to each browser/device
• No server-side storage or synchronization
• Clearing browser data will remove all application data

Data Structure

The system stores data under the key siTpaData containing:

• accounts: Chart of Accounts with balances
• claims: All claim records with reserves
• transactions: All journal entries
• invoices: Generated invoices
• billableRoles: Hourly billing rates

Backup Recommendations

1. Use Developer Tools to export data regularly
2. Save exports to a secure location
3. Test restore process periodically
4. Document your backup schedule

Track the evolution of the SI-TPA Financial System with detailed release notes for each version. Click on any version to expand its details.