Stop Losing Money on Manual Claims Processing
SmartTPA.ai auto-adjudicates 85-95% of health plan claims in under 2 seconds. HIPAA-compliant. Self-hostable. No vendor lock-in. Start with a free 90-day shadow mode pilot — zero risk.
Your Current TPA is Costing You More Than You Think
Legacy TPAs rely on manual processes that are slow, error-prone, and impossible to scale. Every missed denial, every coding error, every delayed claim erodes your margin.
Claims take 14+ days
Manual adjudication queues, paper shuffling, and legacy systems drag turnaround to weeks.
Errors cost $25+ per rework
Coding mistakes, missed denials, and duplicate payments bleed money every month.
HIPAA audits terrify you
The 2026 rule eliminates 'addressable' safeguards. Everything is mandatory now.
Scaling means hiring
Every new employer group means more examiners, more overhead, less margin.
An AI-Native TPA Platform Built for the 2026 Era
SmartTPA.ai replaces your legacy stack with a modular, self-hostable platform that handles claims intake through payment — with AI augmenting every step.
Claims Adjudication in Seconds
Rules engine processes validated claims through plan benefits, fee schedules, deductibles, copays, and coinsurance automatically.
AI-Powered Medical Coding
ICD-10, CPT, HCPCS validation with upcoding detection. 200+ diagnosis codes, 150+ procedure codes validated instantly.
Full EDI Pipeline
Native X12 837P/837I parsing, 835 remittance generation, 270/271 eligibility, 276/277 claim status. No clearinghouse middleware.
2026 HIPAA-Ready
AES-256 encryption at rest, TLS 1.3 in transit, MFA, immutable audit logs, 7-year retention. Every safeguard mandatory-compliant.
Real-Time Eligibility
Sub-second eligibility verification with accumulator tracking, plan benefit lookup, and prior auth detection.
Self-Hostable
Docker + PostgreSQL + Redis + RabbitMQ. No cloud vendor lock-in. Your data stays on your infrastructure.
From Claim Received to Payment in Seconds
Intake
EDI 837 or portal submission parsed and validated in real time.
Enrich
Provider, member, and plan data auto-matched. Duplicates flagged.
Adjudicate
Rules engine applies fee schedules, deductibles, copays, coinsurance, and OOP max.
Pay
835 remittance generated. EOB sent. Accumulators updated. Audit logged.
90-Day Shadow Mode Pilot — Completely Free
We don't ask you to rip out your current system. SmartTPA.ai runs in parallel, processing the same claims, so you can compare results side-by-side. If we don't outperform your current TPA, you walk away with zero cost.
- 90-day shadow mode pilot at zero cost
- Run alongside your current TPA — compare results side-by-side
- No data migration required to start the pilot
- Cancel anytime during shadow mode, no questions asked
- We match or beat your current per-claim processing cost
The Grand Slam Offer
Everything you get with SmartTPA.ai:
- Full claims adjudication engine
- EDI 837/835/270/271 pipeline
- Real-time eligibility verification
- HIPAA compliance out of the box
- Self-hostable (Docker + PostgreSQL)
- Dedicated onboarding specialist
- 90-day shadow mode (free)
- Side-by-side comparison reports
No credit card required. No commitment.
Built for the 2026 HIPAA Security Rule
Every safeguard is mandatory. We don't cut corners.
Ready to Automate Your Claims Operation?
Join the first wave of TPAs replacing legacy systems with AI-native infrastructure. Your 90-day pilot starts the moment you say yes.