Health plan governance software
Reduce a top 10
expense up to 8–12%*
What a contract allows is not always what you should pay.
Most healthcare plans lose 8% to 12% of spend to billing errors, inefficiencies, utilization issues, and contract terms that do not serve the sponsor's interests. VeriAct helps close those gaps and strengthen fiduciary oversight without adding risk or burden to your internal teams.
* Projected; based on Andovia internal analysis. Plan-specific results vary.
Fiduciary oversight only works when the evidence is independent, documented, and usable.
Your vendor is not a fiduciary.
Your TPA pays claims and provides access to care. Your broker finds coverage. Neither carries fiduciary responsibility, and neither is accountable for what your plan costs. As the plan sponsor, fiduciary responsibility is yours.
You know you cannot do it alone.
Most plan sponsors lack the internal resources or expertise to independently verify what their plan is paying and why. The result is accepting cost increases year over year, with no way to properly manage healthcare spend like any other major cost.
Think fiduciary control is happening? The data makes it clear.
More than a decade of forensically audited claims, ingested directly from the TPAs, networks, and PBMs that touch the data. What we see, across commercial and Medicare populations, plan after plan: fiduciary oversight is the exception, not the rule.
CPT code example
186 claims · CPT 45378 · 5.8× spread
Same procedure, same in-network status, across 84 billing TINs in one plan year. Allowed amounts $243–$1,409. Roughly $42.9K above peer-controlled median. Attributable to TPA and network: contracted-rate variance and steerage.
In / out-of-network example
Out-of-network billing pattern
Claims showing recurring out-of-network usage where in-network alternatives existed at the same procedure code. Attributable to network (provider-directory completeness) and plan design (OON pricing rules driving the variance).
Point-of-service example
Facility-rate billing for office-equivalent care
Same procedure code, billed at facility rates in an office-equivalent setting. Attributable to plan design and TPA: site-of-service steerage and benefit-design enforcement.
Projected savings, implementation results vary.
VeriAct is an independent governance layer for self-funded employer health plans.
More than a TPA report-out. Most healthcare reporting tells you what costs went up last month. VeriAct tells you why: which claims were overbilled, miscoded, or driven by care that could have gone another way. Independent, automatic, across every claim and every plan member.
What standard reporting provides
- Show year-over-year cost increases
- List top cost drivers by category
- Provide high-level trend summaries
What they don't do
- Explain why costs are increasing at the claim level
- Identify which costs are preventable or avoidable
- Demonstrate which claims should not have been paid
- Provide claim-level evidence the fiduciary can act on
Insight to action. Verification without action is just analysis. Every review tells you exactly what happened, who is responsible, and what it cost. VeriAct's Advocate Services team helps you act on it: framing the vendor question with claim-level evidence, supporting the plan sponsor's review of steerage and plan-design options, or preparing the case for your next quarterly business review.
VeriAct software platform provides
- Continuous claim-level review, every month
- Vendor-attributed findings with peer-controlled evidence
- Review questions, response tracking, and decision record
- Reproducible methodology for independent review
VeriAct Advocate Services experts support
- Findings interpretation for your plan
- Vendor question framing and dispute preparation
- QBR, renewal, RFP, and committee preparedness
- Independent support with no vendor-chain fees or rebates
How VeriAct works.
VeriAct is a platform backed by a specialized advisory team. The software finds it. The team helps you act on it.
Collect
Your claims data feeds in automatically every month: medical, pharmacy, eligibility, and plan contract terms.
Compare
Every claim is measured against what others with similar plans actually pay, accounting for procedure, setting, and network status.
Identify
Anything that looks wrong gets flagged, attributed to the vendor or decision that caused it, with the dollar amount named.
Follow Through
The platform documents the finding. Our Advocate Services team helps you use it, whether that means framing a vendor inquiry, supporting the plan sponsor's review of steerage and plan-design options, or preparing the case for a quarterly business review.
Example findings: cost inefficiency and financial leakage
Claims Integrity
VeriAct measures: duplicate payments, billing pattern anomalies, and gaps in your TPA's edit rules.
We help you ask and answer:what slipped through the review process, and what is the remediation plan?
Network Cost
VeriAct measures: what you are paying for the same procedure, in the same setting, compared to plans like yours.
We help you ask and answer:where does your contract underperform, and what would bring it closer to market?
Plan Design
VeriAct measures: where your plan document and actual claims diverge, including facility-rate billing and site-of-care patterns.
We help you ask and answer:where is the plan design working against you, and why are you paying facility rates for care that should cost far less?
Member Utilization
VeriAct measures: cost patterns by procedure, provider, and member group before they reach stop-loss.
We help you ask and answer:is your navigation vendor actually engaging the members who need it most?
Behavioral Health Parity
VeriAct measures: whether your behavioral health network is held to the same standard as medical and surgical coverage.
We help you ask and answer:is this a network adequacy problem, or a compliance issue that needs legal review?
True fiduciary oversight does not exist unless it is independent and documented. VeriAct makes that documentation automatic, attributable, and defensible.
Why Health Plan Governance Through VeriAct?
The Data Behind the Solution
The VeriAct governance function runs on Andovia's data platform, built from claims data ingested directly from the parties that touch them: TPAs, networks, PBMs, and benefits administrators. Not scraped files. Not purchased benchmarks. Data from inside the supply chain. We create a longitudinal patient record that makes governance possible.
- Decade of claim-level audit history across commercial and Medicare populations
- Peer-controlled medians at the procedure-, setting-, and network-status level, not category aggregates
- Vendor-attributed findings traceable to the TPA, network, PBM, or plan-design decision that caused them
That is the peer set data your plan is matched against.
VeriAct supports plan sponsors meeting their fiduciary obligations under ERISA §404(a)(1) and the transparency requirements of CAA 2021 §201.
The Company Behind the Solution
Independent
- No revenue from any vendor in your supply chain.
- No commissions, rebates, or referral fees.
Fixed price
- One annual fee, tiered by plan size.
- No percent of savings, no gainshare, no PEPM.
Not a point solution
- Audit every month, every claim, every vendor.
- Not a one-time audit.
Portable
- Change your TPA and your data, benchmarks, and findings stay with you.
See what is happening inside your plan.
Schedule a personalized governance report and see your own claims data: claim-level, vendor-attributed, peer-controlled.*
*NDA protected. First finding delivered within 30 days of data receipt. Andovia responds the same business day.
Peer references available under NDA.