Health Claims Software: Payer-Side vs. Provider-Side (And Which One You Need)
"Health claims software" describes two different products, billing software that submits claims, and payer software that adjudicates and pays them. How to tell which one you're shopping for, and what each has to do.
Read the article →834, 835, 837 EDI Explained: Who's Covered, What Happened, What We Paid
834, 835, 837 EDI explained in plain English, enrollment, claims, and remittance transactions, plus eligibility and status checks, and how they fit together.
Read the article →PMPM Meaning: What Per Member Per Month Actually Means
PMPM meaning explained with a worked example, how per member per month is calculated, how it differs from PEPM, how tiered PMPM rates are applied, and why it matters for software pricing.
Read the article →Switching Claims Administration Platforms: A Migration Playbook
How a TPA, self-funded plan, or healthshare actually migrates to a new claims administration platform, plans, members, claims history, accumulators, and EDI cutover, without disrupting members.
Read the article →What TPA Software Actually Costs in 2026
A straight breakdown of what claims administration software costs a TPA in 2026, setup, base fees, PMPM, and the per-claim fees that quietly add up, and how the all-in-one math changes it.
Read the article →What Is Claims Adjudication? The Full Process, Explained
What is claims adjudication? A walkthrough of how a medical claim moves from intake to payment, eligibility, pricing, cost-sharing, accumulators, and the EOB.
Read the article →The Software Stack to Run a Health Sharing Ministry
The seven systems it takes to operate a health sharing ministry, enrollment, sharing-need processing, billing, member portal, and more, and how Claimaro replaces all seven in one platform.
Read the article →The Software Stack to Administer a Self-Funded Health Plan
The seven systems it takes to administer a self-funded health plan, claims adjudication, EDI, billing, member portals, and how Claimaro replaces all seven in one platform.
Read the article →The Software Stack to Run a TPA
The seven systems it takes to run a third-party administrator, claims adjudication, EDI, billing, white-label portals, and how Claimaro replaces all seven in one platform.
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