The TPA your CFO and HR director will actually agree on.
SmartTPA is the modern platform for self-funded employers who want real-time claims visibility, lower administrative costs, and a member portal employees actually use.
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
Illustrative metrics from a sample 400-member plan — demonstration data, not a specific client.
Every dollar accounted for. Every decision documented. Every member served.
We built SmartTPA for the employer who’s tired of legacy TPAs that are slow, opaque, and quietly expensive. Read more about our platform and full services list.
Catch the claims legacy TPAs miss
Legacy TPAs quietly overpay on 5–10% of claims. SmartTPA's adjudication engine catches the errors before payment — savings land straight on your P&L.
Real-time spend visibility
No more monthly PDFs. CFOs see spend, utilization, and anomalies the moment they happen — with drill-down to any claim.
Onboarding without the slog
Upload your plan document and census. The platform reads the SPD, drafts the benefit rules, and proves the configuration with test claims before you go live.
A member portal employees actually use
Employees get instant cost estimates, deductible tracking, and an AI assistant that answers benefit questions — so HR doesn't have to.
Pharmacy without the spread
Your Rx benefit runs on a pass-through model: the plan pays what the pharmacy is paid, rebates are visible, and the PBM bills you directly. We keep no pharmacy margin.
Your choice of plan design
Reference-based pricing from Medicare-anchored benchmarks with balance-bill defense built in — or a traditional PPO network plan, if that fits your group better. Both run on the same platform.
Independent clinical oversight
Prior auth, case management, and external review run through independent URAC-accredited partners. The reviewer who hears an appeal never made the initial call.
2026 HIPAA, built in
AES-256, MFA, immutable 7-year audit logs. Every safeguard the 2026 Security Rule requires — architectural, not bolt-on.
Transparent reporting
Every claim, every decision, logged immutably. Every fee itemized. Export to your BI tool or pull from our API.
The problems SmartTPA was built to solve.
If you’re the CFO
- Monthly reporting is always 30 days stale — you find problems after they've happened
- Your TPA charges per-claim surcharges you can never audit
- The 5–10% error rate on paid claims is eating your surplus
- You can't tie administrative spend to actual outcomes
- Annual renewals mean another round of contract negotiations and fee surprises
If you’re the HR director
- Employees call HR every day with benefit questions that should self-serve
- You find out about bad member experiences months later in an engagement survey
- COBRA administration eats hours you don't have
- Your TPA's member portal hasn't been updated since 2015
- Enrollment changes take 7–10 days to show up in the system
Live spend visibility — not stale monthly reports.
Every claim, every accumulator, every anomaly — updated in real time. Drill into any metric. Export to your BI tool. Anomaly detection flags high-cost claimants the moment a pattern emerges.
- Real-time claim and spend dashboards
- Automatic anomaly detection and alerting
- High-cost claimant identification
- Benchmark comparisons vs. industry averages
- Export to Excel, CSV, or any BI tool via API
- Claims processed this month
- 3,847
- Auto-adjudicated
- 91.8%
- Average adjudication
- 1.3s
- Mispayments caught pre-payment
- 214
Ready to see the numbers?
Find out what your current TPA is costing you.
Request a proposal or start a free claims analysis. No integration, no risk.