Background on the problem

Self-funded employer plans often look like one payer (e.g. Aetna) at the front desk, but the actual claim needs to be submitted to a TPA (examples of this include Reflect Health, Allied Benefit Systems, and others.). Practices and billing teams often only find out after the claim is rejected or denied, or after the claim status request fails. 

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What's new:

When eligibility returns a benefit-related entity, the agent now extracts the TPA name and matches it to your EDI Payer list. As before, we do conservative name normalization (eg removing corporate suffices or geographic qualifiers) so "Medical Mutual of Ohio" finds "Medical Mutual"

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In this new process, TPA candidates are tried right after eligibility, before wasting attempts on the umbrella payer. This update is automatically included in the Substrate Claim Status Agent, so users should immediately start to experience higher success rates (particularly if your payer mix is TPA heavy).

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