Straight answers on running a self-funded plan.
Practical guides to claims automation, HIPAA compliance, EDI, pharmacy, and plan design — written to be useful whether or not you ever work with us. Each guide shows when it was last reviewed.
Built to meet the strictest healthcare standards
- HIPAA Aligned2026 Security Rule
- Security-First ArchitectureSOC 2 in progress
- AES-256 EncryptionAt rest & in transit
- Immutable Audit Logs7-year retention
- Clearinghouse-Ready EDIClaims in, remittances out
All guides
Reference-Based Pricing, Explained for Self-Funded Employers
How RBP prices claims from Medicare-anchored benchmarks instead of network discounts, what happens with balance bills, what it does to stop-loss premiums, and when it's the wrong fit.
Self-Funded Health Plans: The Complete Guide for Employers
How self-funded health plans work, why employers switch, what a TPA actually does for you, the numbers worth watching, and how to tell if self-funding fits your company.
COBRA: The Compliance Risk Your TPA Carries for You — and How to Verify It
Missed COBRA notices and wrong premiums create legal liability that lands on the plan sponsor, not just the administrator. Here's what airtight COBRA administration looks like.
Denial Management: What Your TPA Should Be Doing — and What to Demand
Half or more of denied claims are recoverable, yet most returned claims are never resubmitted. Here's how to tell whether your TPA's denial management protects your plan — or quietly leaks money.
EDI: The Invisible Plumbing That Decides How Fast Your Claims Get Paid
X12 EDI is how claims, payments, and eligibility actually move. Most plan sponsors never see it — but its quality shows up in payment speed, provider friction, and how fresh your reporting is.
The 2026 HIPAA Security Rule: What It Means for Your Health Plan
The 2026 HIPAA Security Rule eliminates 'addressable' safeguards — every control is now mandatory. Here's what plan sponsors should demand from their TPA before enforcement begins.
Stop-Loss Insurance for Self-Funded Plans: What Employers Need to Know
Stop-loss insurance protects self-funded employers from catastrophic claims. Understand specific vs. aggregate coverage, attachment points, and what your TPA should be doing for you.
Auto-Adjudication Rate: The One Number to Ask Your TPA For
Most administrators auto-adjudicate 40-60% of claims; the best reach 85-95%. Here's why that gap shows up in your plan's cost and member experience — and how to evaluate the answer you get.
The Technology Behind Your Health Plan: Evaluating a TPA's Stack in 2026
Your administrator's technology decides your claim accuracy, reporting speed, and compliance posture. Here's how to see through the demo and evaluate what a TPA actually runs on.
How Automated Claims Adjudication Cuts Processing Time by 90%
Manual claims adjudication takes 3-14 days. Modern rules engines process the same claims in under 2 seconds. Here's how auto-adjudication works and why it matters.
AI-Powered Medical Coding Validation: Catching Errors Before They Cost You
Medical coding errors cost the healthcare industry billions annually. AI validation catches upcoding, unbundling, and invalid code combinations before claims are paid.
Real-Time Eligibility Verification: Why Sub-Second Response Times Matter
Slow eligibility checks delay care and increase denials. Learn how real-time eligibility verification with accumulator tracking transforms TPA operations.
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