The software running your health plan was written before the cloud existed.
Most administrators run a 1990s claims engine wrapped in successive layers of interface, with people filling the gaps by hand where the layers do not meet. That is why reporting is 30 days late, why a benefit change takes weeks, and why 5 to 10 percent of claims are paid wrong. SmartTPA is a rebuild rather than a refresh.
- 2026 HIPAA Security RuleBuilt to it, not retrofitted
- AES-256 encryptionAt rest and in transit
- Immutable audit logs7-year retention
- SOC 2 Type IIIn progress, and we say so
- Clearinghouse-ready EDIClaims in, remittances out
Why it exists
The biggest carriers already solved this. They just kept it.
Large carriers spend hundreds of millions building proprietary adjudication systems, and those systems are genuinely good. Small and mid-size self-funded employers get the leftovers: platforms that are slow, opaque, and steadily falling behind the compliance bar.
The gap is not knowledge. Everything required to adjudicate a claim accurately in under two seconds is well understood. The gap is that nobody had a commercial reason to build it for groups of a few hundred to a few thousand lives.
So the speed, accuracy, and transparency the biggest carriers guard for themselves is what we set out to put in the hands of the employers they left behind, along with plan economics that have no margin hidden inside them.
How we operate
Six commitments, including the ones that cost us something.
Say the unfinished parts out loud
SOC 2 Type II is in progress and this site says in progress. We are early and this site says early. An administrator who blurs the small inconvenient facts will blur the large ones, and you have no way to tell which is which from the outside.
Every fee, disclosed
One transparent administrative fee, open pilot terms, and a published list of every subprocessor that touches your data. Nothing buried in an appendix, and nothing that grows quietly when your plan spends more.
Prevention beats recovery
Catching a mispaid claim before payment keeps the whole dollar. Recovering it later returns a fraction, pays a contingency fee for the privilege, and costs you a provider relationship. We spend our engineering on the first one.
Nobody grades their own work
Clinical review, pharmacy, and reference-based pricing run through independent partners kept structurally separate from us and from each other. An appeal heard by the party that made the first decision is not an appeal.
No lock-in, ever
Documented APIs, standard formats, and full export whenever you ask. If we stop earning the business, your data leaves with you. Data hostage-taking is a retention strategy for administrators who have run out of better ones.
Built for the 2026 rule
The 2026 HIPAA Security Rule eliminated addressable safeguards and made all of them mandatory. We started from that rule rather than migrating toward it, because retrofitting encryption and audit controls leaves gaps that only surface under audit.
The long version
A platform for the next twenty years, not the last twenty.
We started SmartTPA because the options for a self-funded employer are bad in a specific and fixable way. Legacy TPA software predates the cloud. Most administrators still process claims with heavy manual involvement, and industry error rates sit between 5 and 10 percent. Employers cannot see where their dollars went until the month is over. Members wait weeks for a claim to resolve. Compliance gets handled after the fact.
The 2026 HIPAA Security Rule raised the bar again by making every safeguard mandatory. Platforms designed before the cloud will spend years retrofitting controls, and the cost of that retrofit lands on employers and members. We started from the current rule instead of migrating toward it.
The platform uses automation where it demonstrably produces a better result than a person reading a screen: adjudicating clean claims, validating coding before payment, extracting benefit rules from a plan document, and answering member questions against their own coverage. Everywhere a decision requires clinical judgment or carries real consequence for a member, a qualified human makes it and the record shows who.
We are also deliberate about what we do not build. Pharmacy runs through an independent pass-through PBM. Reference-based pricing, utilization review, and external appeals run through established independent partners, each chosen for transparency and each kept structurally separate so nobody grades their own work. We take no margin from any of them. Our administrative fee is the whole of what we earn, which is the only version of that sentence that survives an audit.
- No hidden fees, and no compensation that grows with your spend
- Every claim and every decision logged immutably for seven years
- Automation with accountability attached, never instead of it
- Built for the small and mid-size plans the industry skipped
If you would rather test that than read about it, the claims rerun runs every claim in one of your own files through the engine and shows you what it would have paid.
Test it, do not take it on faith
See what the platform does with your claims.
Send a claims file and we reprice every line. You keep the report, including the version that tells you to stay where you are.