Health plan administration solutions designed to maximize savings, reduce administrative expense and provide access to quality healthcare.

TPA services process,Cost Health Insurance,Medical Cost Containment CompaniesPayerFusion provides a full range of health plan administration, cost containment and medical claims management services to self-funded employers, international insurers and assistance companies. We employ a proprietary cost-plus pricing methodology and access to our privately owned provider network to secure the greatest savings possible for our client partners. Our unique approach includes a strong emphasis on provider relations and improving patient satisfaction with the process of accessing quality care.

  • Better Provider Options – The PayFuseNet network is without walls. No quality provider is excluded, and top performing providers are ranked (by quality and cost) to help you make informed choices.
  • Savings  Our innovative medical claims processing, health plan administration and cost-plus pricing methodology results in superior cost containment, helping you to control the average cost of your medical claims now and over time.
  • Compliance and Peace of Mind  We provide you with expertise and thought leadership so you can stay current with constantly changing state and federal health plan administration laws and regulations as the U.S. healthcare system continues to evolve.
  • Unparalleled Customer Service – PayerFusion has a culture of excellence. Adhering to ISO and Six Sigma Standards, we aim for 100% patient, payer and provider satisfaction.

Our health plan administration service includes...

Medical Claims Management

Full-service medical claim processing and administration solution customized to meet your business requirements.

Medical Case Management

Our highly effective medical case management service reduces billing errors, facilitates prompt payment to providers, maximizes opportunities for savings and ensures that patients are receiving the appropriate care.

PayFuseNet – Our Provider Network

PayFuseNet is our proprietary provider network that gives our clients access to maximum savings and high-quality healthcare providers. Fully compliant with US regulations, Payfusenet has an established presence across the USA, Puerto Rico, the Caribbean, Latin America, Europe, Asia, New Zealand and South Africa. Networks in development include Egypt, Tur­key, India and China.

Technology Solutions

State-of-the-art solutions to support every aspect of health plan administration including online provider search, claim portals and mobile applications.

Cost-Plus Methodology

Our unique Cost-Plus Pricing Methodology assesses each claim compared to national data in order to determine fair reimbursement based on the actual cost of service.

Specialty Services

Providing your members with specialty services can be a strong differentiator in a competitive market. Services include Second Medical Opinion, White Glove Service, Medical Escort and House Call.


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PayerFusion Service Overview