Our TPA services empower clients with access to the entire cycle of policy and medical claims administration.

Our cost containment and medical claims processing achieves claim integrity and bill reductions like no other third party administrator in the U.S.

PayerFusion's innovative TPA services utilize the latest medical claim processing technology coupled with our unique healthcare cost containment methodologies to provide you with the sharpest advantage possible. Our rules-driven medical claim administration tools enable you to remain competitive and compliant in an environment of ever-increasing costs and regulations.

Today’s U.S. healthcare system is fraught with inefficiencies and fraud.

Inflated and fraudulent bills result in $250 billion in unrecovered over payments each year. These over payments are calculated after supposed “discounts” have been applied to retail rates on medical provider bills. The results of such practices are needlessly high per claim costs, which are detrimental to the healthcare system as a whole.

As regulation in the U.S. increases providers are rapidly becoming less willing to agree to blanket or routine discounts – traditional methods of medical claims processing can no longer deliver acceptable results. This is when PayerFusion can help.

PayerFusion approaches in healthcare industry in a manner that aims to “fuse” the gap between payers and providers by creating win-win situations in health benefits and claims administration – including medical claims pricing.

Providers deserve a fair profit based on cost, and payers need more than “discounts” – they need a true cost plus approach to price, which lowers the total amount they pay for claims beyond the PPO discount. PayerFusion employs the latest technology to give you control of your medical claims administration and truly reduces your costs and loss ratios. Cost per claim and policy performance are not forgotten, our TPA services and cost containment process provides excellent reporting capabilities.