Third-party administrators
You administer claims for carriers who each want their own answer.
A TPA sees claims across programs and clients, which is exactly the vantage point a ring is invisible from unless something reads across them. Each client still needs its own record.
Systems
What is usually already there
One claims platform with several programs on it, client reporting obligations, and providers that appear across all of them.
The platform reads what those systems post and nothing else. An entity is billed once it has actually been scored, and one nobody monitors is not.
One platform, separate books
Every case, every finding and every audit row is scoped to the organization it belongs to.
Providers carry a history
A provider appearing on an unusual share of one claimant's history is a finding worth a person.
Reporting your client can read
Cases, verdicts and the measured rate, per program, counted from decisions rather than from a vendor's figure.
The file stays with you
Documents cross as hashes and the claim stays in your platform.
Response
Where an alert goes
A case reaches the desk that handles the program, and the client sees its own numbers.
The ladder is yours to configure. You decide whether an outside agency is reached, and a review nobody actions escalates on its own timer.
Insurance and claims
The vertical this business runs on
Carriers, TPAs, MGAs, and program administrators. Read the details
Other buildings
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