Every operational lever that runs a plan — under one roof.
A modern TPA stack: claims, eligibility, billing, compliance, and direct contracting — built on infrastructure proven across two decades of employer health plan administration.
Three pillars
Purpose-built for employers. Each pillar is independently deployable — adopt the full platform or plug us in alongside an incumbent carrier.
TPA services for employee health plans
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
Claims processing built in-house
Our team authenticates, subrogates, and settles claims for health and welfare, workers' compensation, and captive claims. Adjudication runs on a system built specifically for this business — proven across more than two decades of employer health plan administration.
- EDI Payor ID 52682
- Subrogation & coordination of benefits
- Workers' comp & captive support
Direct primary & urgent care management
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
The full back-office, integrated.
Eligibility management
Real-time eligibility, dependent verification, life-event handling.
ID cards & member portal
Branded ID card production and a self-service member portal.
Single-source billing
One consolidated invoice across vendors with full reconciliation.
COBRA administration
Notices, premium collection, and carrier reporting end-to-end.
ERISA & ACA compliance
1094/1095 filings, SBCs, SPDs, and audit-ready documentation.
EDI claims intake
Direct electronic submission via Payor ID 52682.
Provider service line
Eligibility, pre-cert, case status, and claim status for clinicians.
Member service line
U.S.-based support for benefits, claims, and access questions.
Ready to unbundle your plan?
Tell us about your group. We'll model the savings and show you exactly which pieces of the stack to deploy first.