Eligibility and Enrollment
Eligibility management handles enrollment, life events, and terminations, drawing on our eligibility verification work for coverage confirmation.
Custom Software
Healthcare Software for Employer Health Plans
Self-funded employers are ERISA plan fiduciaries, which means they carry legal obligations regarding plan costs, vendor fees, and coverage decisions. Software serving these plans must therefore support fiduciary reporting while preventing the employer from seeing individual employee health information, since those two requirements pull in opposite directions.
Employer health plan software sits between an employer accountable for plan performance and employees entitled to health privacy. Taction Software builds employer health plan software where that boundary is architectural, alongside the eligibility, claims, and transparency capability self-funded administration requires.
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What Is Employer Health Plan Software
Employer health plan software supports self-funded plan operations: eligibility and enrollment management, claims administration or TPA integration, stop-loss tracking and reporting, network and vendor management, plan document and summary administration, transparency file generation, and fiduciary reporting on plan costs and vendor compensation. The distinguishing requirement is aggregate reporting for the employer alongside strict protection of individual claims detail. Our work sits within our broader healthcare software development practice.
Claims Administration
Claims processing or TPA integration handles adjudication and payment, connecting with our claims processing automation work.
Stop-Loss Management
Stop-loss tracking monitors claims against specific and aggregate attachment points, since late notification can jeopardize reimbursement entirely.
Employer Reporting Boundary
Aggregate reporting gives employers cost and utilization visibility without individual claims detail, which is the boundary that must hold architecturally.
Transparency Compliance
Machine-readable files and cost estimation tools are regulatory requirements for group health plans rather than optional transparency initiatives.
Vendor and Fee Reporting
Fee disclosure supports fiduciary obligations, since plan sponsors must evaluate whether vendor compensation is reasonable relative to services.
Core Employer Plan Services
Our employer health plan software services cover eligibility, claims integration, stop-loss, reporting, and compliance. The architectural decision made first is the data boundary between employer-visible aggregate information and protected individual claims detail, because retrofitting that separation is expensive and doing it badly creates real exposure. Engagements typically open with a review of current reporting practice and where individual detail may already be reaching employer staff.
01
Eligibility Platform
Enrollment systems handle plan year changes, life events, and dependent verification, which drive most administrative volume in plan operations.
02
TPA and Vendor Integration
Integration spans TPAs, PBMs, and networks, drawing on our enterprise application integration practice for data exchange.
03
Stop-Loss Tracking
Attachment monitoring flags claims approaching thresholds, since notification timing requirements are strict and missed deadlines cost recovery.
04
Aggregate Analytics
Cost analytics deliver employer-appropriate reporting, built on our healthcare data warehouse practice with de-identification enforced.
05
Member Engagement
Member-facing tooling draws on our member engagement work, with wellness programs kept separate from employment decisions.
06
Compliance Reporting
Regulatory reporting covers transparency files, attestations, and disclosures that group health plans must produce on defined schedules.
Benefits of Purpose-Built Employer Plan Software
The benefits concentrate in administrative efficiency, stop-loss recovery, and defensible fiduciary reporting. Eligibility errors produce claims problems that surface weeks later, stop-loss notification failures cost real money, and fiduciary scrutiny of plan sponsors has increased. We publish no figures on cost savings, claims performance, or administrative reduction, because those depend entirely on plan design, population, and current operations.
Cleaner Eligibility Data
Accurate enrollment prevents downstream claims problems, since eligibility errors surface as denials weeks after the underlying mistake occurred.
Reliable Stop-Loss Recovery
Threshold monitoring ensures timely notification, since notice requirements are strict and late filing can forfeit reimbursement entirely.
Defensible Fiduciary Reporting
Fee and cost reporting supports the evaluation plan sponsors must perform, which has drawn increased attention and litigation.
Protected Employee Privacy
Architectural separation prevents individual claims detail reaching employer staff, addressing exposure that manual reporting routinely creates.
Transparency Compliance
Required files are generated on schedule rather than assembled manually, addressing an obligation that recurs monthly for group health plans.
Better Vendor Oversight
Performance data across TPAs, PBMs, and networks supports the vendor evaluation fiduciary responsibility increasingly requires.
Our Employer Plan Process
We deliver employer health plan software projects in gated phases so benefits, legal, and IT stakeholders approve direction before engineering cost accumulates. Discovery establishes the employer visibility boundary first, since it shapes the data model and cannot be retrofitted cheaply. We also review where individual claims detail may currently reach employer staff, because that exposure frequently exists informally through reports nobody examined for privacy implications.
Discovery and Boundary Definition
Discovery defines employer visibility against protected detail, since this shapes architecture and existing informal exposure is common.
Eligibility Design
Enrollment workflow handles the plan year, life event, and verification patterns that generate most administrative volume and error.
Integration Development
Integration with TPAs and vendors is built against actual file formats, which vary considerably and rarely match published specifications exactly.
Stop-Loss Configuration
Attachment monitoring is configured against your policy terms, since specific and aggregate structures and notice requirements vary by carrier.
Compliance Implementation
Transparency and disclosure requirements are implemented on their required schedules rather than as periodic manual exercises.
Rollout and Ongoing Support
Rollout aligns to plan year with data quality monitoring and continuing support as regulations and vendor relationships change.
Technology and Compliance
Self-funded plans operate under ERISA including fiduciary obligations, HIPAA where the plan is a covered entity, transparency requirements for group health plans, mental health parity analysis obligations, and disclosure requirements covering vendor compensation. Taction holds ISO 27001 certification. The privacy boundary deserves emphasis: the plan is a covered entity, but the employer as plan sponsor may only receive summary health information and enrollment data absent specific certifications.
HIPAA and Plan Sponsor Boundary
Plan sponsors may receive summary information and enrollment data, not individual claims. Our HIPAA compliance practice defines that separation.
ERISA Fiduciary Obligations
Fiduciary duties cover plan costs and vendor arrangements, requiring documentation that decisions were made prudently and in participants’ interest.
Transparency Requirements
Machine-readable files and cost estimation obligations apply to group health plans on defined schedules with specified content.
Parity Analysis Obligations
Mental health parity requires comparative analysis of treatment limitations, which is a documentation obligation rather than only a coverage design question.
Disclosure Requirements
Compensation disclosure from service providers supports fiduciary evaluation, and plans must obtain and review it rather than assume reasonableness.
Deployment Security
Deployments run in your cloud tenancy or hybrid, with network segmentation, signed container images, and documented penetration testing before release.
Why Choose Taction Software
Taction Software was founded in 2013 and has spent over 12 years building healthcare software, delivering more than 200 healthcare projects from four US offices in Chicago, Cheyenne, Austin, and Sacramento, with ISO 27001 certification. Our relevant discipline is the employer visibility boundary, which we build architecturally rather than through report filtering. The same separation problem appears in occupational health, and getting it wrong creates exposure that surfaces only when someone examines what a report actually contained. Our leadership brings more than 20 years of personal experience in the field.
01
Boundary Built Architecturally
We separate employer-visible aggregate data from individual claims structurally, since report-level filtering leaves detail reachable by other paths.
02
Fiduciary Reporting Support
We build cost and fee reporting supporting the prudent evaluation plan sponsors must document rather than assert.
03
Established Healthcare Focus
Founded in 2013, we have concentrated on healthcare rather than treating it as one vertical among several, producing depth in benefits operations.
04
Multi-Party Data Experience
Our work spans employer, TPA, and vendor data flows, which self-funded administration requires reconciling continuously.
05
Integration Depth
We integrate TPA, PBM, and network feeds against real file formats rather than published specifications that rarely match production output.
06
Certified Security Posture
ISO 27001 certification means security controls are documented and auditable, supporting employer and TPA vendor assessment efficiently.
Pricing
Employer health plan software pricing depends on population size, whether claims administration is in scope or integrated from a TPA, vendor count, and compliance reporting breadth. TPA and vendor integration is frequently the largest component. Discovery produces an itemized, fixed-scope estimate with phase-level breakdown. TPA fees, network access costs, and cloud infrastructure are separate from engineering cost and itemized clearly.
MVP or Single Module
An MVP covering eligibility management or stop-loss tracking typically runs $40,000 to $80,000.
Full Platform Build
A full platform with eligibility, vendor integration, analytics, and compliance reporting typically falls between $80,000 and $200,000.
Enterprise Deployment
Enterprise engagements covering claims administration, multi-vendor integration, and TPA-scale operations start at $200,000.
Discovery Phase Scoping
Discovery is a paid, time-boxed phase producing an itemized estimate, architecture plan, and data boundary model reviewed with counsel.
Cost Drivers to Expect
Vendor integration count, population size, claims scope, and compliance breadth are the largest variables, identified during discovery.
Ongoing Support Costs
Post-launch regulatory changes, vendor transitions, and plan year updates are quoted separately as a retainer sized to population.
Get Started
If you are evaluating employer health plan software for eligibility, stop-loss tracking, plan analytics, or transparency compliance, the fastest next step is a discovery call with our team. We will define the employer data boundary with your counsel and return an itemized, fixed-scope estimate. Contact us to schedule that conversation.
FAQs
Frequently Asked Questions
Benefits and legal leaders evaluating employer health plan software usually ask what the employer may see, how fiduciary reporting works, and whether transparency compliance can be automated. The answers below reflect how we scope these projects.
Summary health information and enrollment data, not individual claims detail, absent specific plan document provisions and certifications. We build that separation architecturally, because informal reporting that includes identifiable detail is a common and largely unexamined exposure in self-funded plans.
By documenting plan costs, vendor compensation, and the analysis supporting decisions. Fiduciary obligations require prudent process rather than optimal outcomes, and prudent process is demonstrated through documentation. Litigation in this area has increased, which raises the value of contemporaneous records.
Largely, yes. Machine-readable file generation and cost estimation tooling follow defined specifications and recur on schedule, which suits automation. The judgment calls sit in data accuracy and completeness rather than in file production itself.
An MVP covering eligibility or stop-loss runs $40,000 to $80,000. A full platform typically falls between $80,000 and $200,000. Enterprise deployments with claims administration start at $200,000. Vendor integration count drives cost most.
No, and usually you should not. Most gaps clients describe involve visibility into TPA operations, stop-loss tracking, and reporting rather than adjudication itself. Building alongside your TPA addresses those without the disruption of changing administrators.
Against your specific policy terms, with claims monitored toward specific and aggregate attachment points and notification prompts before deadlines. Notice requirements are strict, and late filing can forfeit reimbursement entirely regardless of whether the claim itself qualified.