A modern TPA stack: claims, eligibility, billing, compliance, and direct contracting — built on infrastructure proven across a million covered lives.
Three pillars
Each pillar is independently deployable — adopt the full platform or plug us in alongside an incumbent carrier.
Plan operations — Fully insured, level-funded, or self-funded — we unbundle the stack so each component works for the employer instead of the carrier. Plan design, cost containment, claims reduction, provider negotiations, single-source billing, eligibility, enrollment, new hires, and COBRA all get re-architected around your population. • Unbundled, best-of-breed components • Plan design tuned to your population • Carrier-independent cost containment
Adjudication engine — Our team authenticates, subrogates, and settles claims for health and welfare, workers' compensation, and captive claims. Adjudication runs on a system Bill McClure built specifically for this business — proven across 1,000,000+ covered lives and 15,000+ employer groups. • EDI Payor ID 52682 • Subrogation & coordination of benefits • Workers' comp & captive support
Direct contracting — Sometimes a network works; sometimes it doesn't. For populations large enough to direct-contract, we operate 80+ Direct Primary Care providers offering $0 copay services — bypassing the network when it makes financial sense. • 80+ DPC provider relationships • $0 copay member experience • Financial modeling vs. network
Operational capabilities
Real-time eligibility, dependent verification, life-event handling.
Branded ID card production and a self-service member portal.
One consolidated invoice across vendors with full reconciliation.
Notices, premium collection, and carrier reporting end-to-end.
1094 / 1095 filings, SBCs, SPDs, and audit-ready documentation.
Direct electronic submission via Payor ID 52682.
Eligibility, pre-cert, case status, and claim status for clinicians.
U.S.-based support for benefits, claims, and access questions.
Tell us about your group. We'll model the savings and show you exactly which pieces of the stack to deploy first.
