Serving a cross section
of the complex healthcare ecosystem
One platform for the organizations that pay, manage and protect healthcare benefits.
- TPAs: Protect plan dollars and keep your clients
- Health Plans: Pay the right claims. Defend every denial
- Brokers: Price the renewal on evidence, not a quote
- Leave Administrators: Fifty states of leave law, run as one workflow
Third Party Administrators
Your employer clients decide at renewal whether you kept their plan costs down. PulseSync checks every claim before it is paid, and your examiners only see the ones worth a second look. Each flag comes with the evidence behind it, so you can show the employer exactly what was caught and why.
- Payment Integrity
- Utilization & Clinical Review
- Stop-Loss
- Benefits & Leave
Health Plans
PulseSync checks every claim before it is paid and reviews prior authorization and medical-necessity requests against the clinical record. Each determination quotes the parts of the record it relied on, so it holds up on appeal. A physician makes the final call on every medical-necessity denial.
- Payment Integrity
- Utilization & Clinical Review
Brokers
Most renewal analysis is rebuilt by hand, under deadline, from claims data the group already has. PulseSync keeps that picture current all year. It tracks high-cost claimants and each group's position against its attachment points, and flags a catastrophic claim while there is still time to act. Large claims are reviewed before they are paid.
- Stop-Loss
- Payment Integrity
- Utilization & Clinical Review
Benefits & Leave Administrators
One leave case can involve FMLA, a state paid-leave program, a doctor's certification, several notices and a payroll change, each with its own deadline. Thirteen agents handle that sequence from intake to the payroll instruction and keep every notice on time. Your team steps in when a case needs judgment.
- Benefits & Leave
- Payment Integrity