Send us last year’s claims file. We will show you what it should have cost.
SmartTPA reports spend as it happens and catches mispaid claims before the money leaves. Start by testing that on claims you have already paid. Every line is checkable against a remittance already in your files, and if the difference does not justify switching we say so in writing.
- 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
The problem, from two chairs
The CFO and the HR director are describing the same broken system.
One of you is looking at a number that arrives too late to use. The other is absorbing the consequences in person, all day.
If you are the CFO
- Reporting is 30 days stale, so you find problems after they have finished happening
- Per-claim surcharges you have no practical way to audit
- The 5 to 10 percent industry error rate is eating your surplus quietly
- No way to tie administrative spend to anything that happened
- Every renewal is another round of fee surprises
If you are the HR director
- Benefit questions that should self-serve arrive at your desk daily
- You hear about bad member experiences months later, in a survey
- COBRA administration eats hours nobody budgeted
- A member portal that has not changed since 2015
- Enrollment changes take a week to appear in the system
How we get paid
Nine ways a TPA can make money off your plan. We take one.
One should sound like a marketing number. So here are all nine, including what we would charge if we charged it, and the question that surfaces each one. Every line below is a real way administrators earn from self-funded employers, and most of them are legal, common, and invisible on your invoice. Read the list, then ask your current administrator to go down it with you.
- We take
Administrative fee
One disclosed per-employee charge. This is the whole of what we earn, and it is the same number whether your plan has a quiet year or a catastrophic one.
- We do not
Pharmacy spread pricing
Billing the plan more than the pharmacy was paid and keeping the difference. Our pass-through PBM bills you directly, so those dollars never touch our books.
- We do not
Retained pharmacy rebates
Manufacturer rebates kept rather than passed on. Ours are reported and belong to the plan.
- We do not
Network access fees
A per-member charge for routing claims through a network, often paid back to the administrator as a rebate. We retain none of it.
- We do not
Cost-containment contingency fees
A percentage of whatever a vendor claws back after payment. It rewards finding errors late. We catch them before payment, which earns us nothing extra and saves the plan the whole dollar. Subrogation is the one place a specialist is genuinely required: an independent firm pursues the liable third party and takes a contingency out of what it recovers. You can pick that firm yourself, you see their rate, it passes through at cost, and we keep none of it.
- We do not
Out-of-network repricing markup
A margin added when an out-of-network claim is repriced. We add none.
- We do not
Per-claim and per-transaction surcharges
Charges per claim, per ID card, per report, per EDI file, usually in an addendum nobody reads twice. There are none in our agreement.
- We do not
Float on claim funds
Interest earned while holding a plan's pre-funded claim account. Your funding stays with you until claims are paid, so there is no float for us to earn.
- We do not
Undisclosed vendor commissions
Overrides from stop-loss carriers, clinical vendors, or pricing partners. We take no margin from any partner we contract, and every engagement carries CAA-compliant compensation disclosure.
Every line on that list except the first one pays more when your plan spends more.
That is the whole problem with how this industry is paid, and it is why an administrator can be genuinely helpful and still cost you money. Ours is the one line that does not move, which means the only way we grow is by keeping plans long enough that they renew.
See what the fee actually coversWhat changes
Every dollar accounted for. Every decision documented.
Read the detail on the platform and the full services list.
The overpayments stop being yours
Legacy administrators pay 5 to 10 percent of claims wrong and rarely mention it. Coding validation and pre-payment edits catch those before the money leaves, so the difference lands on your P&L instead of in a recovery vendor's contingency fee.
You see spend while you can still act on it
Claims, utilization, and anomalies update as they land. A high-cost claimant surfaces while case management can still change the trajectory, rather than in a report that arrives after the quarter closed.
Your pharmacy spend is what the pharmacy was paid
An independent pass-through PBM bills your plan directly, keeps no spread, and reports rebates. Nobody in the chain earns more when the drug costs more, which is the whole reason drug spend behaves the way it does elsewhere.
The fee does not move when your spend does
One disclosed administrative charge. No per-claim surcharges, no repricing markup, no vendor compensation hidden inside the plan's own spend. Your administrator has no financial reason to want your claims larger.
HR stops running a benefits help desk
Members get cost estimates before care, live deductible status, and answers grounded in their own plan document. The routine questions resolve before they reach anyone on your team.
Onboarding does not consume a quarter
Upload the plan document and census. The platform reads the SPD, drafts the benefit rules, and proves the configuration against test claims before a real one is processed. You review and confirm rather than dictate a plan into someone else's system.
Clinical decisions sit with clinicians
Prior authorization, case management, and external review run through independent URAC-accredited partners. The reviewer who hears an appeal is never the one who made the first call, which is the structural reason an appeal means anything.
The plan design is your choice, not a template
A traditional PPO network plan or a reference-based design, both on the same engine, with network contract rates applied automatically during adjudication. Changing benefits at renewal is configuration, not a development project.
Your fiduciary file writes itself
Every claim and every decision is logged immutably for seven years. When a regulator, an auditor, or a member's attorney asks why a claim paid the way it did, the answer is a record rather than a recollection.
Reporting
A number you can act on beats a number you can only file.
Every claim, accumulator, and anomaly updates as it happens. Drill into any figure down to the claim line. Export it anywhere. Anomaly detection flags a high-cost claimant the moment the pattern emerges rather than the month after.
- Live claim and spend dashboards, not a monthly PDF
- Anomaly detection and alerting on emerging patterns
- High-cost claimant identification from live claims data
- Benchmark comparisons against industry averages
- Export to Excel, CSV, or any BI tool through the API
Sample view
- Claims processed this month
- 3,847
- Auto-adjudicated on this book
- 91.8%
- Median adjudication time
- 1.3s
- Lines corrected before payment
- 214
A demonstration plan populated with synthetic data, shown to illustrate the reporting format. Not a client, not a result, and not a projection of what your plan would show.
Before you ask
The four questions that decide this.
We have been with our TPA for years. Why move?
Length of tenure is not evidence of accuracy, and the two are easy to confuse. Run the rerun on your own claims file. If the difference is immaterial, that is a genuinely good outcome and you now have documentation that your incumbent is pricing correctly, which is worth having at renewal either way.
A transition mid-year would be a disaster.
Which is why nothing in the first two steps touches your live plan. The rerun is a file. The parallel run is a copy of live claims processed alongside your current administrator. You watch both answers for as long as you want before anything moves, and run-out handling is planned before a go-live date is set.
How do I know the savings are real and not a sales model?
Because the report is computed on your claims, priced line by line, and you can check any line against the remittance your current administrator already sent you. That is the entire reason we lead with your data rather than a case study.
Who is accountable when something goes wrong?
We are, including for the partners we contract. Pharmacy, reference-based pricing, and clinical review run through independent specialists, chosen for transparency and kept structurally separate so none of them grades their own work. We take no margin from any of them and we do not route you to them when there is a problem.
Start with your own numbers
Find out what your current TPA is costing you.
Send the claims file. We reprice every line and show you the difference. If it is not worth switching for, we will tell you that.