Before Care
Compare appropriate care options and available prices, then coordinate approved arrangements before planned services.
How Transperra Creates Value
Reduce the cost of care. Improve what your plan can offer.
Transperra brings navigation, clinical support, pricing intelligence, prescription advocacy, negotiated care arrangements, and claims support together around a participating health plan. The objective is to reduce the underlying cost of care and use the savings to create a better plan.
Better Purchasing. Better Benefits.
Put the price of care into the conversation before the bill.
Network access gives members a way to seek care, but access alone does not establish that the price is competitive. The same service can carry different prices depending on the provider, facility, and payment arrangement. Transperra helps evaluate appropriate options and available pricing before planned care whenever possible. Our team pursues cash-pay negotiations, direct contracts, single case agreements, and bundled arrangements to establish clearer terms. When claims arrive, review, negotiation, and repricing address additional opportunities. The goal is a better financial outcome for the plan and the member, with savings evaluated after applicable fees.
When Claims Arrive
Evaluate medical charges, pursue appropriate negotiation and repricing, and help coordinate resolution of billing issues.
Across the Plan
Measure the resulting costs, applicable fees, member benefits, and savings retained by the plan.
Your Health Plan Should Do More Than Pay Expensive Claims
Rising plan costs put pressure on your business. Deductibles and prescription costs put pressure on your people. Too often, no one helps either side find a better option before the bill arrives.
You Cannot Manage Prices You Cannot See
- The same service can carry very different prices across facilities and payment arrangements.
- A network discount alone does not tell you whether the final price is competitive.
- Transperra evaluates available pricing and provider information to identify better options before planned care.
Coverage Should Not Leave Employees Afraid to Use It
- Employees need help understanding where to go, what to expect, and how to access their benefits.
- Eligible Transperra members can receive covered navigated care at $0 out-of-pocket when they engage and follow approved arrangements.
- Personal guidance helps members take the next step with greater confidence.
Expensive Prescriptions Need More Than a Copay
- High-cost medications deserve an individual review of available savings options.
- Transperra Rx evaluates assistance programs, eligible 340B pathways, and domestic and international sourcing options where available and permitted.
- Our team helps qualifying members navigate the process and understand the next steps.
A Paid Claim Should Not Be the End of the Story
- Medical bills and claims deserve review, pricing evaluation, and negotiation when appropriate.
- We coordinate with plan partners to pursue fair payment arrangements and help address billing issues.
- Reporting connects the work performed to the resulting plan and member savings.
Illustrative example · Why Engagement Matters
The Same Need for Care. A Different Path to Paying for It.
Illustrative Traditional Plan
Without a Coordinated Arrangement
Member Cost
$4,100
- Assumed allowed scan cost: $8,500.
- Assumed remaining deductible: $3,000.
- Assumed coinsurance: 20% of the remaining $5,500, or $1,100.
- Illustrative member cost: $4,100, assuming no other benefits or out-of-pocket limits change the calculation.
- Illustrative plan cost: $4,400.
Eligible Covered Navigated Care
With Transperra Engagement
Member Cost
$0
- The member contacts Transperra before the planned scan.
- The team evaluates available providers, pricing, and approved payment arrangements.
- The member follows the approved arrangement under an eligible Transperra plan.
- Eligible member out-of-pocket cost: $0 under the plan's navigation benefit.
- The employer's savings depend on the actual negotiated price, applicable fees, and comparison benchmark.
Illustrative Traditional Plan
$4,100
Eligible Covered Navigated Care
$0
Illustrative example, not a quote or actual case study. Eligibility, approved arrangements, plan terms, authorization requirements, and applicable plan rules govern benefits. PPO medical care does not receive the Transperra navigation waiver.
Program Options
Three Ways to Structure Your Benefits Approach
Choose the approach that fits your workforce and your strategy.
Health Plan with Transperra
Medical navigation and cost containment, exclusive prescription advocacy, and $0 out-of-pocket for eligible covered navigated care when members follow approved arrangements.
- Medical navigation
- Included
- Medical $0 out-of-pocket
- Included for eligible covered navigated care
- Prescription advocacy
- Required, exclusive
Transperra Bridge
Offer a PPO option and a Transperra option within the same employer group. Employees choose at enrollment. Medical navigation and its $0 benefit apply to the Transperra option; exclusive Rx advocacy applies to both.
- Medical navigation
- Transperra option only
- Medical $0 out-of-pocket
- Transperra option only
- Prescription advocacy
- Required on both options
PPO with Transperra Rx
A PPO approach with required exclusive Transperra prescription advocacy. PPO members do not receive Transperra medical navigation or its medical out-of-pocket waiver. Eligible prescription engagement benefits follow the plan.
- Medical navigation
- Not included
- Medical $0 out-of-pocket
- Not included
- Prescription advocacy
- Required, exclusive
Options depend on group eligibility, underwriting, participation, plan design, and available partners. Ask us to evaluate the right fit.
Request a Plan ReviewMedical Navigation and Member Advocacy
Transperra helps eligible members understand available care options and coordinate approved arrangements before planned services. Navigation connects pricing information with personal support, while nurses, doctors, and other clinical professionals support the program within their roles. The team helps members make informed choices and access care; treating clinicians remain responsible for medical decisions. Eligible covered navigated care can be $0 out-of-pocket under the member’s Transperra plan.
How Medical Savings Become Real
A better price only matters when someone helps arrange it.
- Medical navigation: Guide eligible members through available provider and care options.
- Direct contracts: Establish negotiated terms with providers for defined services.
- Cash-pay arrangements: Evaluate available cash prices and coordinate approved payment arrangements through the program.
- Single-case agreements: Negotiate terms for a specific patient's service or episode.
- Bundled care: Evaluate a defined price for an episode when an appropriate arrangement is available.
- Claims review and negotiation: Evaluate charges and pursue fair payment arrangements within the program's scope.
- Billing advocacy: Help coordinate resolution when a member receives a bill or encounters a payment dispute.
Members should contact Transperra before planned care so the team can confirm the arrangement and applicable benefits.
Medical navigation and its out-of-pocket waiver apply to Transperra plan designs, not PPO options—including the PPO side of Transperra Bridge.
Transperra Rx Advocacy and Sourcing
We evaluate high-cost prescriptions for manufacturer and patient assistance, eligible 340B pathways, and domestic and international sourcing where available and permitted. Our team helps qualifying members navigate the process while coordinating with plan and pharmacy partners.
What Transperra Rx Evaluates
Every prescription deserves the right review. There is no single savings route that works for every medication or member.
- Drug advocacy: Review the medication and available savings pathways with member and plan support.
- Manufacturer Assistance Programs (MAP): Evaluate manufacturer-sponsored assistance and applicable eligibility requirements.
- Patient Assistance Programs (PAP): Evaluate qualifying patient-assistance options and help with required steps.
- Eligible 340B pathways: Evaluate access through eligible participating entities and applicable program requirements. Employer enrollment alone does not establish eligibility.
- National/domestic sourcing: Evaluate U.S. sourcing options and participating pharmacy arrangements where available.
- International sourcing: Evaluate eligible medications through available program partners where permitted and appropriate.
- Specialty medications: Review available assistance, sourcing, and site-of-care opportunities when applicable.
- PBM coordination: Work with the plan's pharmacy structure and available partner options to support the selected strategy.
Available options depend on the medication, coverage, member eligibility, and program requirements. Transperra helps evaluate the options and coordinate next steps with the appropriate professionals.
Claims Review, Negotiation, and Billing Advocacy
We evaluate medical charges and payment opportunities, pursue appropriate negotiations, and coordinate with plan partners on claim and billing issues. We help employers understand the savings achieved and members understand what happens next.
- Medical bills and claims deserve review, pricing evaluation, and negotiation when appropriate.
- We coordinate with plan partners to pursue fair payment arrangements and help address billing issues.
- Reporting connects the work performed to the resulting plan and member savings.
Cash-Pay Negotiations, Direct Contracts & Single Case Agreements
The price of care can vary by facility, provider, and payment arrangement. Transperra pursues cash-pay negotiations, direct contracts, single case agreements, and bundled arrangements when appropriate. The team works to establish a competitive price and clear terms, coordinated through the program before eligible planned care.
Members should contact Transperra before arranging planned services. The team confirms the applicable process and payment arrangement; “cash-pay” does not mean members should assume they must pay personally and seek reimbursement later.
Arrangements are evaluated case by case. Not every mechanism is used on every claim, and no arrangement is assumed until the team confirms it before planned care.
Spectis Health Pricing and Analytics
Spectis brings available pricing, claims, benchmark, and quality information together to help identify cost variation and savings opportunities. Your team can compare options, support purchasing decisions, and track the results of cost-containment efforts.
What Spectis Health Adds
www.spectishealth.comPricing transparency becomes useful when it helps someone make a better decision.
- Bring together available hospital and insurer machine-readable pricing data, paid-claims information, Medicare benchmarks, and cash-price information.
- Compare available provider, facility, service, and pricing information to identify meaningful variation.
- Incorporate available quality information alongside pricing when evaluating care options.
- Support assessment of direct contracts, cash-pay arrangements, bundled care, and claim payment opportunities.
- Help plan teams identify where to focus navigation and cost-containment work.
- Support reporting that distinguishes gross savings, program fees, and net savings against a stated benchmark.
- Offer transparency tools and partner configurations consistent with the selected implementation.
Data availability, refresh timing, configuration, and service scope vary. A listed or estimated price is not a confirmed care arrangement. Request a demo to see the capabilities available for your use case.
Request a Spectis Demo
Member App and CareSync Console
The member app connects people with their benefits and support team. CareSync supports communication among navigators and participating plan partners. Together, they help turn an identified opportunity into a coordinated next step.
People and Technology Working Together
An Easy Way for Members to Engage. A Shared Place for Teams to Coordinate.
- Member app: Access available benefits information and connect with the support team.
- Personal support: Ask for help before planned care or when a prescription or bill needs attention.
- CareSync Console: Support communication among navigators and participating plan partners.
- Spectis Health: Bring pricing intelligence and analytics into the decisions behind the care arrangement.
The Bundled Ecosystem
An integrated program supported by savings.
Navigation, clinical resources, pricing intelligence, prescription advocacy, negotiated arrangements, claims support, and member tools work together around the selected plan. The percentage-of-savings model helps support these integrated capabilities without treating every included service as another separate monthly add-on.
- 01Medical Navigation
- 02Pricing Intelligence
- 03Rx Advocacy
- 04Direct Arrangements
- 05Claims & Billing Support
- 06Member Technology
What Happens Behind the Scenes
The team identifies opportunities, helps members understand the process, coordinates approved arrangements with participating partners, and documents activity and results. Available services depend on the program and agreement; not every service is used by every member or on every claim.
Who We Serve
Built Around the People Who Make the Plan Work
Employers: Control Costs Without Leaving Employees to Figure It Out Alone
Give your business a more active way to manage medical and pharmacy spending. Transperra combines cost-containment work with member support and, in eligible Transperra plans, $0 benefits that reward engagement.
- Medical and pharmacy cost strategies
- Member education and support
- Documented savings reporting
- Program options evaluated for your group
Brokers: Bring Clients a Clear Alternative to Another Cost Increase
Help employers understand how their plan buys care, where savings opportunities may exist, and how eligible members can benefit from engagement. Transperra supports the conversation with program expertise, implementation coordination, and documented results.
- Transperra, PPO with exclusive Rx advocacy, and Bridge options
- Client and member education
- Pricing and analytics support
- Coordinated evaluation and proposal process
TPAs: Add Cost-Containment Capabilities to Your Offering
Transperra works with participating TPAs to coordinate medical and pharmacy strategies, member engagement, and technology. Agree on the scope, data exchange, roles, and workflows before implementation.
- TPA-agnostic partnerships
- Member app and CareSync options
- Spectis pricing intelligence
- Medical negotiation and pharmacy advocacy within the selected program
Employer support
Eligible max-funded clients can access included HR advisory support. Additional services and projects may be separately priced.
Program Economics
Understand the fees. Evaluate the complete result.
Transperra reports savings after applicable savings-based fees. The complete comparison considers the resulting care cost, program fees, separately payable expenses, and member benefits. Purchasing savings and final employer financial savings are measured separately.
Under the applicable agreement, Transperra earns a percentage of defined medical or prescription savings. That compensation supports navigation, advocacy, purchasing, technology, and included program services. Selected vendor access charges may be absorbed within the compensation and are not charged again to the employer.
When a result is reported as net savings, the applicable savings-based fee has already been included in the resulting cost. Do not add that fee again. Separate administration, technology, optional-service, or other charges identified in the proposal must still be considered when evaluating total plan economics.
Covered treatment and prescriptions remain plan expenses under the applicable terms. The objective is a better complete financial result, supported by useful services and qualifying member benefits. Actual employer results also depend on funding, stop-loss reimbursement, and refund or credit provisions.
Savings help support the program.
Percentage-of-savings compensation helps support the people, program services, technology, and resources behind Transperra’s work. The selected agreement defines the fee calculation, caps, included services, and separate charges. Evaluate the program by its scope, the work performed, and the savings retained after applicable costs.
Applicable fee terms
- Medical, navigated claims: 15% of defined savings, capped at $25,000 per claim.
- Medical, non-navigated claims under an applicable Transperra arrangement: 12% of defined savings, capped at $25,000 per claim. This does not mean navigation is offered on PPO plans.
- Prescription advocacy: 25% of defined savings, uncapped.
These are applicable contractual terms under current Transperra agreements, not a universal promise of how every offering is priced. Your proposal and agreement govern.
Illustrative savings comparison
An Example of Why Final Cost Matters
Based on a $100,000 claim
Illustrative billed charges
$100,000Illustrative PPO discount
45%Transperra net discount after fees
70%Difference in illustrated total cost
+25 pts
In this illustrative example, total cost is $25,000 lower after applicable Transperra fees: $30,000 compared with the assumed PPO allowed amount of $55,000. Employer and member costs depend on the plan’s cost-sharing and funding arrangements.
Gross reduction
Benchmark minus resulting cost of care or medication.
Applicable fees
Percentage-of-savings fee under the agreement, with any caps.
Separate charges
Administration, technology, or optional services identified in the proposal.
Net savings
The reduction against the stated benchmark after applicable savings-based fees. Final employer savings require a separate funding reconciliation.
Questions
Frequently Asked Questions
What is Transperra?
Transperra is a healthcare cost-containment company. We combine medical and pharmacy strategies, member support, and pricing intelligence to help employers manage costs and help members access their benefits.
How does $0 out-of-pocket work?
Eligible Transperra members contact the team, follow an approved arrangement, and meet their plan requirements for eligible covered navigated care. The team confirms the applicable benefit. App downloads and independent provider searches do not automatically create a waiver.
Does a PPO option include medical navigation?
No. PPO options require exclusive Transperra Rx advocacy, but do not include Transperra medical navigation or its medical out-of-pocket waiver. In Bridge, those medical benefits belong to the Transperra option. Eligible pharmacy engagement benefits depend on the plan and qualifying program.
What is Transperra Bridge?
Bridge allows an eligible employer group to offer both a PPO option and a Transperra option. Employees choose at enrollment. The program must meet applicable eligibility, underwriting, participation, and contribution requirements.
Does every medication qualify for assistance or alternative sourcing?
No. Available options depend on the medication, member eligibility, coverage, and program requirements. The Rx team evaluates available pathways and helps coordinate the next steps.
What does Spectis Health do?
Spectis supports pricing comparisons, benchmark analysis, opportunity identification, and reporting using the data and configuration available to the implementation. Transperra uses that intelligence to support actual care and cost-containment decisions.
Can Transperra work with another TPA?
Yes, through participating TPA partnerships and an agreed implementation. Scope, technology, data exchange, and operational responsibilities are established for the selected program.
Do members have to use the app?
Members must complete the initial education before qualifying for waived out-of-pocket costs on eligible navigated care. Members with a compatible smartphone are expected to download and maintain the app. Members without a smartphone can engage through counselor support or email. Applicable navigation and plan requirements still apply.
Is Transperra paid only when a member uses the app?
Fees depend on the selected services and agreement. All services Transperra provides use a percentage-of-savings structure; administration, technology, or other services may have separate charges. App activity alone does not describe the whole financial model.
What happens if a provider sends me a balance bill?
Contact Transperra promptly through your approved support channel. We help coordinate review with the administrator and applicable advocacy partners. The response depends on your plan, the service, the arrangement, and the nature of the bill.
See whether Transperra fits your plan.
Talk with our team about your group, your goals, and the information needed for an evaluation.
