Go ahead. Follow the money.
Between your account and the doctor’s office, a claim dollar passes through more hands than most employers ever see. Scroll, and follow one.
It starts in your account, and it stays there.
Your funding sits in your own account until a claim is paid. We never hold it, so there is no float for us to earn.
Every line is checked before the dollar leaves.
This lab billed one blood test twice. The second charge was stopped at the gate, so the money never left and nobody had to chase it back.
Eight places it could leak. All closed.
A TPA can make money off your plan nine ways. We take one disclosed fee. Open the other eight to see what they look like when an administrator uses them.
- Our administrative feeOne disclosed line
- Pharmacy spread pricingClosed
- Retained pharmacy rebatesClosed
- Network access feesClosed
- Contingency feesClosed
- Repricing markupClosed
- Per-claim surchargesClosed
- Float on your claim fundsClosed
- Vendor commissionsClosed
Lines that grow when your plan spends more: 0
It lands where it was meant to.
The doctor is paid the plan’s price. At the pharmacy, your plan pays what the pharmacy was paid, with no spread on top. And your employee carries this.
SmartTPASample EmployerHealth Plan
Jordan Rivera
SMT 4821 0093 · GRP 100482
- Office
- $25
- Specialist
- $50
- Urgent
- $75
- ER
- $250
Payer IDSMART
Payer ID SMART is on both sides.
Now run last year’s money through it.
Send one claims file. We reprice every line and show you what it should have cost. You see every number, and the report is yours to keep.
Rerun my claimsor write to [email protected]
Four people follow this money.
- EmployersSee every dollar as it moves, and stop funding claims that were paid wrong.For employers
- BrokersWalk into the finals meeting with a number, not a deck.For brokers
- MembersKnow what care costs before you go, not when the bill arrives.For members
- ProvidersEligibility before the visit, payer ID SMART, and a remittance that explains itself.For providers
Questions we would ask in your chair.
- Is software going to deny my employees’ claims?
- No. Administrative decisions follow the plan document, anything outside those rules goes to a person, and medical necessity is never automated.
- Switching administrators is a nightmare.
- It is, which is why the first two steps never touch your live plan. The rerun is a file. The parallel run is a copy.
- You are new. Why hand you a health plan?
- We are early and onboarding our first groups now. So start with your own claims file. You compare two numbers computed on data you already own.
- Where does SOC 2 stand?
- Type II is in progress, and we say so. Encryption, immutable audit logging, and least-privilege access are running now.
- Do I have to leave my broker?
- No. We work with brokers, not around them. Yours keeps the relationship and gets reporting that makes renewal easier.
- When are you the wrong answer?
- When the lowest fee in the RFP is the deciding metric, when a national carrier name on the ID card is a must, or when nobody will look at the claims data.