Simplify claims and payments
Connect the care delivered to the payment process.
A direct contract only pays off if the claim and the payment follow. HealthMe turns each bundle into a claim the TPA can process, or an invoice and ACH payment for employer-direct groups, so your practice gets paid on the agreed schedule without re-keying anything.
Where direct-contract payments stall
Employer-direct care is simple for the patient. Behind the scenes, the payment side is where it breaks down.
Claims systems expect line items
A bundle has one price, but TPA systems are built for itemized fee-for-service claims, so someone has to translate it by hand.
Every group pays differently
Some groups pay through a TPA, others pay the practice directly. Staff end up tracking the rules for each one.
A surgical bundle has several payees
The professional, facility, and anesthesia portions all need to be paid, and each one waits on the same episode.
What changes with HealthMe
| The moment | Today | With HealthMe |
|---|---|---|
| Billing a bundle | Staff break the bundle into line items by hand | The bundle becomes an EDI claim at the time of service and goes straight to the TPA |
| Submitting a claim file | Re-keying details from a PDF into a portal | Upload the PDF or CSV and review the extracted details |
| Choosing the payment path | Staff remember each group’s rules | Routing is set up once per group: an 837 claim to the TPA, or an employer invoice and ACH payment |
| Paying a surgical bundle | Each provider bills and follows up separately | Payment is coordinated across the professional, facility, and anesthesia portions when they’re in the agreement |
What launch looks like
Set up the payment path once per group, then let every claim follow it.
- Week 1
Map your groups
List each employer group, whether it pays through a TPA or directly, and its payment schedule.
- Week 2
Configure routing
HealthMe sets up each group’s claim format, recipient, and payment path.
- Week 3
Send your first claims
Submit the first bundles and claim files, with HealthMe reviewing them alongside your team.
- Week 4+
Make it routine
New claims follow the configured path automatically.
Products in this solution
Walk through your claim routing
Bring a list of your employer groups and how each one pays today. We’ll show you how the setup works.