THIRD PARTY ADMINISTRATORS (TPAs)
Flexibility to Scale and Deliver for Clients.
TPAs are under pressure to control costs, meet diverse client needs, and deliver measurable results. Claritev can help you improve claims accuracy, reduce administrative friction, and support consistent execution across clients.
Turn customization into a competitive advantage.
Tailor solutions for every client.
Adapt network and cost management strategies to meet diverse client needs while maintaining efficiency and consistency.
Help capture more savings.
Identify savings opportunities, support improved payment accuracy, and apply targeted cost management strategies across the claims lifecycle.
Make informed decisions.
Gain visibility into performance, utilization, and cost drivers with actionable insights that support informed decisions.
Show employers the results.
Give employers clear evidence of savings, fewer billing errors, and consistent plan administration.
Solutions built for TPA operations.
From cost management to payment optimization and strategic insights, Claritev can help TPAs catch billing errors, reduce manual payment work, and spot cost trends earlier.
Network Solutions
Primary Networks
Access customizable, NCQA-accredited provider networks, including our national PHCS® PPO and our regional PHCS Novera PPO, with flexible configurations designed to help TPAs meet diverse client needs, manage healthcare costs, and support access to quality care.
Complementary Networks
Expand provider access and fill gaps in primary networks with flexible solutions, including our MultiPlan network, that help TPAs extend coverage, manage costs, and support member access across markets.
Cost Management & Payment Integrity
Advanced Code Editing
Identify coding inconsistencies and potential billing errors through intelligent automation and expert clinical review to help improve claims accuracy and reduce unnecessary costs.
Financial Negotiations
Achieve additional savings through claim-specific negotiations on facility and professional claims while helping reduce the risk of unexpected member billing.
Payment Optimization & Efficiency
Claritev Payments
Streamline payment workflows with secure, scalable payment solutions that can improve efficiency, reduce administrative burden, and support stronger provider relationships.
Strategic Insights & Analytics
BenInsights® Performance Intelligence
Access actionable healthcare data and analytics to uncover trends, measure performance, and make informed decisions.
Turning Transparency Data Chaos into Reimbursement Intelligence
Transparency data is transforming reimbursement strategy, but only when it can be trusted and applied effectively. Discover how Claritev turns complex pricing data into actionable intelligence for informed out-of-network reimbursement decisions.
Stay ahead of the healthcare cost challenges your clients are facing.
Explore practical research, guides, and perspectives designed to help TPAs manage healthcare costs, optimize performance, and deliver greater value to employers and members.
-
Every Claim Tells a Story: What Your Claims Are Really Saying About Your Business
Every claim contains valuable insights beyond reimbursement. From coding accuracy and documentation quality to operational efficiency and financial performance, claims data can reveal opportunities…
Read More -
Turning Transparency Data Chaos into Reimbursement Intelligence
Transparency data is transforming reimbursement strategy, but only when it can be trusted and applied effectively. Discover how Claritev turns complex pricing data into…
Read More -
Rethinking Reference-Based Pricing
Reference-based pricing is evolving to meet the demands of rising healthcare costs, shifting market conditions and changing business priorities. This white paper explores how…
Read More
Ready to use flexible solutions to deliver for your clients?
See how Claritev can help your organization lower claims costs, simplify payments, and give employers clear insight into plan performance.