One platform to administer every health plan client you serve, adjudication, X12 EDI, enrollment, and provider payments, with each client’s plan designs and data kept separate. Zero per-claim fees as you grow.
Nine systems most vendors sell separately for administering health plans: adjudication, EDI, enrollment, payments, and reporting all included.
Claims that meet a client’s plan rules process straight through without a keystroke. Anything that needs judgment, a suspected duplicate, a high-dollar claim, a member status issue, pends into the adjudicator queue with the reason attached, so staff work exceptions instead of re-keying the routine. We don’t publish a benchmark auto-adjudication rate; bring your book of business to a walkthrough and watch the adjudication engine run against it.
Plan designs, benefit tiers, and cost-sharing are configured per plan, so a change to one plan never touches another. Each client’s plans live in that client’s own environment, built by your team with the same tools you use for every client.
Bring members in through online enrollment or a CSV import from the client, then keep eligibility current in that client’s environment. Claims check coverage on the date of service, and providers can run real-time eligibility checks through your clearinghouse.
Native X12, 837 claim intake, 835 remittance generation, with clearinghouse connectivity built into the platform for every client you administer. That’s infrastructure most vendors sell as a separate module or a middleware contract; here it’s included from day one and shared across your whole book.
Payment runs that produce payment files and a check register for your bank, EOB generation, and remittance advice for every provider you pay, on the same schedule and controls in every client you run, with payment history and 1099 tracking kept for each provider.
Members and providers see claim status, benefit lookups, and their own documents through a portal that shows only their own records. Because each client runs in its own environment, each one can carry its own branding, while your team works them all with the same tools.
Providers request prior authorizations in the provider portal or by X12 278, and your team approves, denies, or pends each one, with the decision sent back electronically.
Pend reasons, aging queues, and threshold notifications route to the right staff automatically, so a claim that’s been sitting for days surfaces instead of aging silently in a shared inbox. Alerts go to the adjudicator assigned to the claim.
Each client’s reporting comes from its own environment, so the group that wants its own numbers gets exactly theirs. No exporting from six systems to assemble one board deck.
Most claims platforms are built to run a single health plan well. A TPA runs dozens, each with its own plan designs, fee schedules, provider networks, and reporting requirements, and that changes what the software underneath needs to do.
Claimaro gives every client its own isolated environment, built on the same platform behind our self-funded health plan software. Each client carries its own benefit plans, fee schedules, and provider network, and its member and claims data live in its own database, so one client never sees another’s numbers.
Adding a client means our team provisions a new environment, then your team builds the plan and maps the fee schedule with the same tools and workflows you use for every other client.
Reporting stays per client: pull a single client’s numbers for their broker meeting straight from that client’s environment.
| Feature | Claimaro | Typical per-claim platform |
|---|---|---|
| Pricing model | Quoted for your book | Per claim processed |
| Per-claim fees | None | Yes, scales with volume |
Platform cost that rises with claim volume penalizes exactly the growth a TPA is trying to achieve.
TPA software is the core administrative platform a third-party administrator runs its client health plans on. It handles enrollment and eligibility, claims intake over X12 EDI, adjudication against each client’s plan design, provider payments, and member and provider portals. The distinguishing requirement versus single-plan software is multi-client architecture: one platform administering many client groups, each with its own plan designs, fee schedules, and reporting, with data segregated between them.
Software. Claimaro does not administer plans or compete with our customers for their business. We build the platform TPAs run on. That distinction matters when you are evaluating vendors, because some platforms in this market are owned by organizations that also sell administration services.
Yes. Each client runs in its own isolated Claimaro environment, with its own plans, benefit rules, fee schedules, provider network, and reporting, and its member and claims data in its own database. Your team works every client with the same tools, and our team provisions a new environment when you sign a client.
Yes, natively, 837 claim intake, 835 remittance generation, and eligibility and prior authorization transactions, with clearinghouse connectivity built into the platform rather than sold as a separate module or a middleware contract.
Claimaro quotes TPA pricing for your book, and it never charges per-claim fees. Most of this market prices per claim processed, which means your platform cost rises with the claim volume you take on, the opposite of how a TPA’s economics should work as it grows.
Claims history, member and group records, plan configurations, and accumulator balances migrate together, so in-progress deductibles and out-of-pocket totals carry over rather than resetting mid-year. Migration timing is usually driven by plan-year boundaries rather than by the software.
Twenty minutes, your client roster, live in the product. Or read the seven systems it takes to run a TPA, see what TPA software actually costs, or compare Claimaro to PLEXIS. Weighing a build-your-own platform against a venture-backed TPA? Read Claimaro vs Yuzu Health.