Run your own plan on modern software instead of a legacy claims payer bolted to six other vendors. Adjudication, EDI, enrollment, billing, and member portals — one login, published pricing, zero per-claim fees.
Administering a self-funded plan takes five to seven systems. Claimaro is all of them, in one.
A priority-rules engine prices each claim against your plan design with cost-sharing and real-time deductible and out-of-pocket accumulators — see the full adjudication engine it runs on.
Native 837 claim intake, 835 remittance generation, and eligibility transactions, with clearinghouse connectivity built in — not a separate module.
A member-facing enrollment wizard plus enrollment funnels, household and dependent capture, e-signature, and the eligibility system of record.
Contribution billing across Stripe, NMI, and Authorize.net, provider disbursements, and 1099-MISC and W-9 tracking for the providers you pay.
Branded portals for claim status, PDF EOBs, digital ID cards, and documents — so members and providers self-serve instead of calling.
Full CRM, email and SMS, enrollment funnels, and automations in the same system — the growth stack most claims platforms leave out entirely.
Most claims platforms bill you per transaction, so your software cost grows every time your team pays a claim — a tax on your own throughput. Claimaro is base plus PMPM only. Your enrollment can double and your platform cost doesn't move a dollar. On a plan where you already carry the claims risk, that's the last cost you want indexed to your success.
Every plan runs on its own isolated database — not rows in a shared schema. HIPAA-grade controls are in the product: PHI encryption in transit and at rest, PII masking, always-on audit logging, and role-based access, all on SOC 2 Type II-audited infrastructure, with a BAA included on every plan. A new environment provisions in minutes, not an implementation cycle.
To administer a self-funded plan you need enrollment and eligibility, claims adjudication that prices against your plan design and tracks real-time deductible and out-of-pocket accumulators, X12 EDI (837 intake, 835 remittance), contribution billing and provider payments, member and provider portals, and the reporting your plan and stop-loss carrier rely on. Bought separately that is five to seven vendors. Claimaro is all of it in one platform.
Software. Claimaro is the platform a self-funded plan runs on — you can self-administer it, or a TPA can run it on your behalf. Either way it is one system rather than a claims payer bolted to an enrollment tool bolted to a billing platform.
Yes. A priority-rules engine adjudicates each claim against your plan with pricing, cost-sharing, and real-time accumulators, and native X12 EDI handles 837 claim intake, 835 remittance generation, eligibility transactions, and clearinghouse connectivity.
Claimaro models spec and aggregate scenarios in its plan design and actuarial tools and produces the claims and financial reporting your stop-loss carrier needs to process reimbursements. It does not administer individual stop-loss policies (lasers, per-member deductibles) today — placement and administration stay with your broker and carrier.
Claimaro is published, flat pricing: from $3,500/month + $5 PMPM with a $15,000 setup, and zero per-claim fees. Your platform cost does not grow every time your team pays a claim. Run your member count through the calculator to size it against a multi-vendor stack.
Migration is a guided project our team runs with you — plans rebuilt with your codes mapped as aliases, members and claims history imported, accumulator balances carried over so a mid-year switch does not reset deductibles, and EDI and payment rails stood up in parallel before you flip.
Book a 20-minute walkthrough and we'll scope your migration — plans, members, claims history, accumulators — before you commit. Or read the full software stack a self-funded plan needs, or how Claimaro compares to the incumbents.