The Challenge for TPAs
Increasing Fiduciary Pressure
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Self-funded employers and captives rely on TPAs to manage claims, networks, and compliance. But when the same entity approves claims and audits payments, conflicts of interest can expose both the employer and TPA to risk.
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Key Pain Points:
Network Relationship Conflicts: Pressure to approve questionable claims to maintain contracts.
Shared Savings Dilemma: Auditing after payment means profit on avoidable errors.
Hidden Costs & Liability: Opaque fees and CAA “gag clause” risks increase exposure.
Become A Fudiciary Partner
ClaimInformatics helps TPAs deliver independent, transparent fiduciary oversight—before payments go out.
Why Claiminformatics Pre-Pay Independence by Design​
ClaimInformatics delivers independent fiduciary oversight and payment integrity controls that TPAs need. Our Pre-Pay Solution protects plan assets by detecting issues before funds are released—eliminating conflicts of interest and ensuring compliance. Our independent Pre-Payment Fiduciary Review system integrates seamlessly with your claims workflow—delivering compliance, accuracy, and transparency in one solution.
Reduction in Inappropriate Spend
Targets 6-9% reduction through prospective claim review (vs. 2–5% post-pay recovery).
CI FOCUS Pre-Pay Solution
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ClaimInformatics provides true independence in pre-payment claims reviews.
Your Path Forward To Fiduciary Oversight Excellence
"It's separation of powers for healthcare claims review —
It's how fiduciary responsibility should work."
ClaimInformatics stands out as the sole all-in-one solution that offers fiduciary protection, converting raw claims data into valuable strategic insights. Our platform transparently minimizes liability, upholds compliance, and achieves significant cost savings. With our SOC 2 certification and HIPAA compliance, we provide enterprise-level oversight usually available only to large organizations, now within reach for self-funded plans and TPAs of any size.
Independent Pre-Payment Fiduciary Oversight for TPAs
Compliance: Aligns with ERISA and CAA obligations.
Risk Mitigation: Reduces exposure to penalties and litigation.
Member Protection: Safeguards plan assets while ensuring fair reimbursement to providers.
Prevent Waste: Stop incorrect payments, billing errors, and contractual discrepancies.
Strengthen Fiduciary Protection: Demonstrate measurable prudence, transparency, and compliance.
Improve Cash Flow: Dollars are not erroneously spent and don’t need to be recovered later.
Reduce Administrative Burden: Avoid lengthy recovery cycles and provider friction.
The Path Forward
Let’s Build Fiduciary-Strong Plans Together
ClaimInformatics is your behind-the-scenes partner for fiduciary compliance and payment integrity. We complement, not compete with your core claims operation.
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How to Start
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Schedule a fiduciary alignment consultation
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Connect your claim workflow or TPA platform (SFTP for EDI 834, 835, 837, CSV, and pipe-delimited files)
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Start delivering conflict-free claim oversight