Audit & Payment Integrity Platform for TPAs

A payment integrity audit reviews claim files, payments, reserves, documentation, and decision points to identify leakage, inconsistencies, overpayment risk, under-reserving, missing support, or process breakdowns. For TPAs, the goal is not only to find errors after payment, but to improve claim handling, documentation quality, reserve discipline, and settlement decisions before costs escalate.

OraClaim structures unorganized claim files into searchable intelligence, extracts key facts, flags inconsistencies, benchmarks similar claims, and monitors exposure changes as new records arrive. TPAs can use these insights to review payment drivers, assess reserve adequacy, produce carrier-ready evaluations, and identify patterns across portfolios that may otherwise remain hidden in PDFs, emails, and spreadsheets.

Yes. OraClaim surfaces issues tied to leakage, including treatment gaps, causation concerns, conflicting statements, unverified details, reserve mismatches, panel-firm cost outliers, under-reserved cohorts, and emerging exposure changes. The platform gives claims teams a structured view of the facts and financial drivers so they can intervene earlier and make more defensible decisions.

OraClaim can integrate with practice management and document management platforms upon customer request, including Clio, MyCase, Smokeball, PracticePanther, NetDocuments, iManage, Worldox, and Box. These integrations help teams connect existing documents and workflows to OraClaim’s classification, benchmarking, drafting, exposure analysis, and portfolio reporting capabilities without rebuilding their operating model.

OraClaim is designed as a closed, access-restricted system for attorneys, claims professionals, and authorized representatives. The company emphasizes industry-standard security measures around encryption, authentication, and data protection. Its architecture supports confidential collaboration and is built for defense and claims workflows where privilege, work product, and sensitive claims information require careful handling.

TPAs can generate claim summaries, key fact reports, case evaluations, reserve recommendation memos, exposure-change alerts, portfolio dashboards, loss assessment views, settlement authority support, benchmarking reports, and financial impact analysis. Outputs can support carrier reporting, internal audits, roundtable reviews, panel management, reserve discussions, and leadership-level visibility into claims performance.

OraClaim is designed to cut review time in half by automating document ingestion, classification, fact extraction, medical chronology creation, case evaluation drafting, and benchmarking. Some modules deliver first drafts in minutes, while typical bodily injury medical chronology first drafts can be generated in under 60 minutes once the case file is ingested.

OraClaim is built for TPAs, claims professionals, insurance carriers, defense law firms, self-insured corporations, captives, claims managers, Chief Claims Officers, and teams overseeing high-volume or high-exposure claims. It is especially valuable for organizations that need consistent evaluations, stronger reserve discipline, outside-counsel alignment, and portfolio-level insight without adding headcount.