Verq converts your plan documents into version-controlled, executable logic. When the auditor asks — or the stop-loss carrier disputes — the answer takes minutes, not weeks of reconstruction.
Audit exposure. Profit erosion. Providers turning your claims team into a call center. These aren't edge cases — they're the operating reality for most TPAs today.
The claim was processed correctly. You know it. But when the stop-loss carrier challenges it, you can't reconstruct the exact rule logic that was active 18 months ago. Correct decisions that look indefensible.
Auditors arrive wanting three years of decision logic — exactly what rule applied, on what date, supported by what plan language. What should take hours takes weeks of forensic reconstruction.
A custom plan build takes weeks and thousands of dollars in staff time. If that employer leaves within three years — and many do — that investment is a total loss. Industry data shows plan build costs consume 28% of profits on churned accounts with a sub-3-year tenure.
Only 36% of TPAs can send automated eligibility responses to providers. The other 64% field those calls manually. Providers don't stop calling — they just call louder. Your claims team spends half its day answering eligibility questions instead of adjudicating claims.
Verq doesn't replace your claims system. It makes every decision your system produces reproducible, cited, and defensible.
Upload your Summary Plan Descriptions, plan amendments, benefit schedules, and COB rules. Verq reads the governing language — not an interpretation of it.
SPDs · Amendments · SchedulesPlan language becomes executable logic. Every rule set is versioned and timestamped. When your plan changes, a new version is created — the old one is preserved, not overwritten.
Version control · Immutable historyEvery claim is adjudicated against the specific rule set that was active on the date of service. No manual overrides. No interpretation gaps. The plan document is always the source of truth.
Deterministic · Zero overridesPull any decision record — with the rule version, the plan document citation, and the complete logic trail — in seconds. Stop-loss disputes. DOL audits. Employer questions. Answered with proof, not belief.
Cited · Replayable · ExportableEvery action, change, and settlement event is chronologically recorded and tamper-evident. Need to know what logic was active on March 15, 2022? Replay it exactly.
Tamper-evident · Full audit trailUpload one page of your benefits schedule. We'll show you the first claim decision it can defend — and the first one it can't.
Benefits schedule, SPD, or plan excerpt
PDF · TXT · DOC · DOCX — max 10MB
Your document is analyzed then discarded. We'll email you the findings.
Extracting benefit rules, mapping claim scenario, checking compliance
The complete findings with exact citations and remediation steps have been emailed to —. Check your inbox (and spam folder) within the next few minutes.
A full Verq audit covers every benefit category, maps all ambiguities, and version-controls your plan logic. Most TPAs discover 3–7 critical gaps in the first session.
This tool uses AI to identify potential claim adjudication ambiguities. It does not constitute legal or compliance advice. Results should be reviewed by a qualified benefits attorney before making plan administration decisions.
| Capability | ✦ Verq | Legacy Systems |
|---|---|---|
| Automated eligibility responses | Real-time 270/271 responses to providers — no inbound calls | Manual only — 64% of TPAs have no automation, fielding calls all day |
| Plan build economics | Logic lives in the plan document — builds are faster, reusable, version-controlled | Manual builds consume 28% of profits on accounts that churn under 3 years |
| Claim logic versioning | Full version control — every rule change tracked | None — rules overwritten, history lost |
| Plan document citations | Every decision cited to governing SPD section | Manual — requires forensic reconstruction |
| Historical decision replay | Any decision, any date, exact rule version | Not possible — logic state not preserved |
| Stop-loss dispute support | Reproducible proof with plan citation | Best-effort belief — "we think it was correct" |
| Manual overrides required | Eliminated — plan document is the source of truth | Common — creates undocumented interpretation gaps |
| Audit preparation time | Minutes — pull any record instantly | Weeks — all-hands reconstruction effort |
| Employer decision transparency | Real-time — cited decision available on demand | Delayed — "let me look into it" |
Mid-market TPAs administering self-funded employer plans who are tired of losing stop-loss disputes they should win and spending weeks preparing for audits they should be able to answer in hours.
HR and benefits leaders at self-insured employers who need to trust their TPA's decisions and be able to explain them to a CFO — without waiting days for an answer.
We built Verq because we kept seeing the same crisis play out across the TPA industry. Competent, careful administrators losing stop-loss disputes. Spending weeks reconstructing decision trails for audits that should take hours. Watching employer clients erode their trust — not because claims were wrong, but because no one could prove they were right.
The root cause was always the same: claims systems were built to process fast, not to prove later. Verq was built to change that. When your plan document becomes the executable source of truth — version-controlled, cited, and replayable — correct decisions stop being a matter of belief and start being a matter of record.
That's not a technology story. It's a trust story. And trust, in this industry, is everything.
Ready to talk?
info@verqhealth.com
Upload one page of your benefits schedule. We'll show you the first claim decision it can defend — and the first one it can't. Takes two minutes. No sales call required.