PBM & TPA Licensure

Ensure Compliance for PBMs & TPAs

Ensuring compliance and maintaining licensure is crucial for TPAs and PBMs to operate legally and competitively across various states. We offer comprehensive solutions to manage your licensure needs, whether you’re entering new states or renewing existing licenses.

What We Do

Simplifying TPA and PBM Licensure Across All States

Life and Health Administrator License for TPAs

TPAs must hold a license to operate in any state where they provide services. Licenses typically require renewal every one or two years, involving extensive paperwork and management. Whether you’re expanding into new states or maintaining current licenses, we can manage the entire process for you.

Certificate of Authority for PBMs

Some PBMs may believe they are fully licensed in all states but discover gaps that can lead to significant risks, including fines up to $10,000 per day for operating without proper licensure. We help you avoid these risks by ensuring your PBM is fully licensed in every state you operate.

Licensing Expertise

Our goal is your regulatory success.

Here’s how we make it happen:

Regulatory Liaison

We assess your current licensure status across all states—identifying any gaps and communicating with regulators on your behalf, saving you significant time and effort.

Licensure Management

We handle the entire process of obtaining and renewing licenses.

Dashboard Overview

Get a real-time view of licensure statuses across all 50 states, including approvals and pending applications.

KnowledgeBase Tool

Stay updated with key provisions, new statutes, policies and media relevant to TPA/PBM licensure.

Automated Regulatory Filing

Our intelligent SaaS solution ensures a seamless and simple user interface for filing success through automated, real-time access to state guidance, streamlined integration and dissemination of binder, form and rate filing deadlines and requirements.

Feature

ClearFile Workflow Tracking

Our ClearFile software preloads all required forms—no need to scrape through DOI websites—and tracks their status, providing a comprehensive view of your licensure progress.

With Activities and Collaboration, users can:

Gain a complete, real-time understanding of all tasks and team activity, improving project oversight.
Identify potential issues early on, preventing project derailment and boosting efficiency.
Discuss and address queries, overdue tasks or other issues directly within the activity feed.