Your plan document is the contract.
Make it enforceable.
Your SPD, network contracts, stop-loss terms, and formulary rules become executable logic. Know if your TPA is following the plan. See why claims are denied. Verify every payment at the claim level.
You're spending millions on claims. Do you have visibility into how?
Aggregate reporting shows the big picture. Claim-level verification shows what's actually happening.
See how verification worksSelf-funded plans are inherently complex.
Network contracts renegotiate. Formularies update quarterly. Stop-loss thresholds reset annually. When four systems interact across thousands of claims, gaps are inevitable, not a sign of failure.
How it works.
Your plan document and contracts become executable logic. Know if your TPA is following the rules. See why claims are denied. Verify every payment independently.
Your plan becomes executable logic
Your SPD, network contracts, stop-loss terms, and formulary rules become executable specifications. Every benefit rule, exclusion, and rate becomes a verifiable check.
Verify payments. Explain denials. Flag TPA drift.
Each claim checked against your plan document, network contracts, and stop-loss thresholds. Underpayments surface with the specific rule. Denials get explained: is the TPA following your SPD, or not?
Recover. Correct. Govern.
Underpayments include the SPD clause and variance amount. Wrongful denials include why the plan covers it. TPA drift includes the root cause so you can fix it, not just find it.
Every layer of your plan, verified.
Network discounts. Stop-loss flagging. Denials your employees shouldn't have received. Every component that determines what you pay, modeled as logic and independently verified.
Where complexity creates gaps.
These aren't rare edge cases. They're the natural result of complex plans with multiple moving parts.
Stop-Loss Recovery Opportunity
A member's claims exceed $175K across multiple providers and billing cycles, but because they're split across separate records, the total isn't aggregated for stop-loss filing. The reimbursement opportunity goes unnoticed.
Contract Update Lag
Your network contract was renegotiated in January with improved rates, but the adjudication system still reflects the prior schedule. Every in-network claim processes at the old rate until someone catches it.
Plan Amendment Sync Gap
Your SPD was amended to exclude a category of services, but the system's exclusion code table wasn't updated. Claims auto-adjudicate as covered because the logic doesn't reflect the latest plan language.
Dollar amounts shown are illustrative · Variance findings consistent with published employer plan audits
From aggregate reports to claim-level clarity.
Independent verification doesn't replace your TPA. It holds the plan document as ground truth so you can see what's working, what's not, and why.
Send us your plan document.
See what the logic reveals.
Start with one quarter of claims. Within a week, you see every underpayment, every denial explained, and where your TPA diverged from the plan. Works alongside your existing TPA.