You fund every claim your health plan pays. Verq checks every one of them against your plan document — and shows you what matched, what didn’t, and what it’s costing you.
§6.2 · Utilization Mgmt “Inpatient admissions require prior authorization…”
Claim: $900,000 admission, paid in full — against a $250,000 stop‑loss attachment point. Prior authorization: not on file.
| Adjudicated per the plan $650,000 reimbursed to your plan above the attachment point — filed with the proof | Departs from the plan $650,000 reimbursement denied or clawed back — your plan’s cost |
Same claim. The stop-loss carrier checks every line against your plan before it pays.
Who checked before the filing?
Misapplied cost-sharing. Benefits paid outside the plan’s terms. Exclusions that weren’t applied. Each one is small. Across a year of claims, they’re a line item — one nobody is itemizing.
When a large claim hits your attachment point, the carrier’s first move is to check whether it was adjudicated per the plan. If it wasn’t, reimbursement gets denied or clawed back — and the plan eats it. The worst time to discover an adjudication error is inside a stop-loss dispute.
Surprises aren’t a strategy. Verq’s continuous verification reads the whole claims stream against the plan — utilization, performance, and what’s accumulating toward your attachment points — before it lands.
A claim denied against the plan’s own terms doesn’t stay a claims issue. It becomes an HR issue, then a retention issue, then occasionally a legal one. Catching departures early keeps them boring.
Plan sponsors have a duty to monitor the people running their plan — and courts are increasingly asking employers to show their work. “We trust our TPA” is not documentation. A record of every claim checked, with citations, is.
Every claim comes back as one of three verdicts, each cited to the exact plan section that governs it.
Most claims match. That matters too: it’s proof your plan is being run right, in a file you can show.
Not an accusation — a finding. Resolved with a question to the TPA, a written instruction, or a correction.
The plan is ambiguous or silent. The finding drives a documented interpretation or a note for renewal.
Most of what Verq finds gets fixed with a conversation. That’s what oversight looks like when it’s working.
Before a single claim is pulled, Verq reads your governing documents — the SPD and, where one exists, the wrap or master plan document — and flags the ambiguities, the gaps, and the places the documents disagree with each other. Those are the provisions a claim decision can’t defend.
Through your plan’s data rights, every adjudicated claim is checked against the plan. We provide the data-request template; your advisor can run the process.
Continuous verification as claims are adjudicated — errors caught while they’re correctable, and cash-flow visibility while it’s still foresight.
Verq is delivered by benefits advisors as part of plan stewardship. If you have a broker or consultant, ask them about running a Verq audit — many already deliver it as part of their service.
To guide that conversation, we made a one‑page checklist — six things your plan’s reporting should show you, from the governing documents to stop‑loss tracking. Get it below and bring it to your next broker meeting.
One page, no spam — just the checklist to guide your stewardship conversation.
Check your inbox — we just emailed you the checklist.
Download the checklist (PDF)Prefer to talk it through first? Talk to the founders — 20 minutes
Most TPAs do good work — and most claims will match the plan. Trust is not the issue; verification is. The difference is a record.
It’s a verification of the plan. Findings are framed as three plain verdicts, not accusations, and most resolve with a question or an instruction. TPAs that administer plans well come out of this looking good — provably.
A paid-claims report is a total. It can’t tell you whether any claim followed the plan, and it can’t defend a stop-loss reimbursement. A number is not an answer.
Verq starts with a plan-document audit that requires nothing but the document. Pricing scales with the plan from there — talk to your advisor or to us.