You cannot look at every claim
Manual review scales with headcount, so it gets rationed to a sample. Everything outside the sample is paid without a second look.
Who we serve / TPAs
Protect plan dollars and
keep your clients
TPAs adjudicate millions of claim lines a year on thin margins, for employers who can move their plan at renewal. What keeps them is the cost you keep out of their plan, and findings you can show them with the evidence attached.
The problem
What gets
in the way
Every renewal is a retention test
A one to two percent reduction in paid claims is the difference between renewing a group and losing it, and the employer will ask where the savings came from.
The vendor keeps the upside
A contingency vendor paid a percentage of what they find has every reason to keep finding things. You are renting a capability you should own.
Solutions
What TPAs use
PulseSync for
-
Payment Integrity
Every claim read at adjudication, before it is paid, with the evidence for each finding.
See the capability -
Utilization & Clinical Review
Prior authorization and medical-necessity review for the plans you administer, each determination citing the record.
See the capability -
Stop-Loss
High-cost claimant and exposure tracking for your employer groups, on the claims data you already load.
See the capability -
Benefits & Leave
Leave administration from intake to payroll, for the employers that want it run alongside their medical plan.
See the capability
Every capability runs on the same platform, built from the same skill library and governed the same way, so adding one means new agents on a platform you already run, not a new vendor. See the platform
Next step
See it on your
own data
We run your historic records through the agents and show you what each one finds, with its evidence, before anything is switched on.