Integrated Payor Solutions

What Integrated Payor Solutions does

Integrated Payor Solutions (IPS) is a San Francisco-based SaaS provider that builds cloud-based claims administration and transparency compliance software for healthcare organizations managing complex health plans. The company's primary customers are Third-Party Administrators (TPAs), Administrative Services Organizations (ASOs), provider networks and PPOs, Taft-Hartley and multi-employer plans, and Medicare Advantage organizations. IPS positions its platform as a replacement for fragmented legacy systems, centralizing claims processing, automated adjudication, and regulatory compliance within a single Salesforce-native environment.

The platform consists of two products: Encompass+, the flagship claims administration system offering rules-based adjudication, end-to-end claims management, multi-plan configuration, and operational oversight; and Transparency+, a compliance module that automates No Surprises Act (NSA) and Transparency in Coverage (TiC) workflows, including machine-readable file generation, data validation, audit support, and price comparison tools. Both products are built natively on Salesforce, leveraging its security infrastructure, API capabilities, and HIPAA, SOC 2, and HITECH-aligned controls. Notable technical components include an AI plan build automation feature that uses document intelligence and machine learning to parse unstructured plan documents (reducing configuration timelines from weeks to hours under a human-in-the-loop model), structured provider data management with validation and ongoing auditing, and API-ready integrations with payment vendors (QuickBooks, Checkeeper), communication tools (Outlook), clearinghouses, and carriers (Cigna, integrated in 60 days for a Texas-based TPA).

IPS operates on a per-member, per-month (PEPM) subscription model with no upfront implementation fees, and billing does not begin until the platform is fully configured and operational, aligning vendor growth to client membership growth. The go-to-market is entirely direct and enterprise-focused, with human-assisted sales cycles structured around exploratory demos and working sessions, complemented by content marketing, SEO, and conference participation (SIIA, HCAA Executive Forum). Founded in 2015 by CEO Shawn Evans, the company grew through 2016 acquisitions of Podiatry Plan and East West Administrators, which served as real-world testing grounds for platform development, and maintains DC Risk Solutions as a wholly-owned subsidiary.

Name

Integrated Payor Solutions

Legal name

Integrated Payor Solutions

Website

https://integratedpayorsolutions.com

Company type

Private

Founded year

2015

Operating status

Operating

Headcount range

11–50 employees

Short description

Integrated Payor Solutions is a Salesforce-native SaaS provider of claims administration (Encompass+) and No Surprises Act / Transparency in Coverage compliance (Transparency+) software, serving TPAs, ASOs, provider networks, Taft-Hartley plans, and Medicare Advantage organizations on a per-member, per-month subscription model.

Ownership category

akta.pro rank

Product category

Healthcare Claims Administration Software

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821), Financial Transactions Processing, Reserve, and Clearinghouse Activities (522320)

SIC

Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)

akta.pro secondary industries

Policy Administration, Underwriting & Rating Platforms (Core Insurance SaaS) (FSAGAGAB), Patient Financial Engagement (Estimates, Billing Presentment, Payments) (HLACAEAI)

Keywords

• Claims administration software
• Health plan administration
• No Surprises Act compliance
• Transparency in coverage
• SaaS healthcare technology

Headquarters

HQ city

San Francisco

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations, Infrastructure

Revenue model

1. Subscription - Per-Member Per-Month (PEPM): IPS generates revenue through a recurring per-member, per-month (PEPM) subscription model. There is no upfront implementation fee, and billing does not begin until the platform is fully configured and operating. The model is designed to align IPS's growth with client success — the company grows as the client's membership grows.

Pricing tiers

Go-to-market motion1 record

Distribution channels1 record

Marketing channels5 records

Core offering

Integrated Payor Solutions sells two cloud-based SaaS platforms built natively on Salesforce. Encompass+ is a claims administration platform that automates adjudication, supports rules-based plan configuration, and provides operational oversight for TPAs, ASOs, provider networks, Taft-Hartley plans, and Medicare Advantage organizations. Transparency+ is a compliance platform for No Surprises Act (NSA) and Transparency in Coverage (TiC) requirements, providing automated machine-readable file generation, regulatory reporting, audit support, and price comparison tools. Both products are offered under a per-member per-month subscription pricing model.

Product overview

Integrated Payor Solutions offers two integrated cloud-based SaaS products built on Salesforce: Encompass+ as the core claims administration platform providing automated adjudication, plan management, and operational oversight, and Transparency+ as a compliance add-on focused on No Surprises Act and Transparency in Coverage Rule requirements including machine-readable file generation and price comparison tools. Both products share the same Salesforce infrastructure and can operate independently or together within a unified ecosystem.

Differentiator

Problem solved

Functional benefit

Brands

• Encompass+: Cloud-based claims administration software platform built on Salesforce for TPAs, provider networks, ASOs, Taft-Hartley plans, and Medicare Advantage organizations that automates adjudication, strengthens compliance controls, and scales with complex health plans.
• Transparency+

Products and services

• Encompass+ Cloud-based claims administration software built natively on Salesforce for TPAs, ASOs, provider networks, Taft-Hartley plans, and Medicare Advantage organizations. Provides rules-based automated adjudication, end-to-end claims management, configurable multi-plan administration, AI-embedded plan build automation, operational visibility, and API-ready integrations within a unified SaaS environment.
• Transparency+ Purpose-built Salesforce-native platform for No Surprises Act and Transparency in Coverage compliance. Automates machine-readable file generation, supports NSA workflows and TiC reporting, provides data validation and normalization, scheduled publishing, audit-readiness monitoring, price comparison tools, and integrates with Encompass+ or operates standalone.

Quantifiable outcome

• Plan build timelines reduced from weeks to hours via AI plan build automation
• +4 more outcomes

Named customers6 records

Segments5 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

AI capability5 records

Feature5 records

Partnerships

Five partnerships are on record, tiered core and minor.

• Harmony Third Party Administrator (Evolve Association)coreStrategic or Co-development Partner · 27 February 2025IPS implemented Encompass+ for Evolve Association's Harmony Third Party Administrator. Evolve Association is a benefits and wellbeing organization empowering members nationwide. IPS addressed Harmony's need for an online enrollment project that other vendors had said was not possible or would take extremely long. The implementation enabled rapid benefits administration and modernized the TPA's technology infrastructure.
• Yuzu HealthcoreStrategic or Co-development Partner · 19 September 2023IPS partners with tech-powered TPA Yuzu Health to deliver a new generation of self-funded health plans. Yuzu leverages Encompass+ and Transparency+ to offer creative plan offerings, rapid claims adjudication, and compliance with NSA/TiC. IPS implemented platform updates within a 90-day timeline, providing Yuzu with direct access to reporting tools, hourly claims status syncs, and integration data. Yuzu provides technology expertise as a self-hosted TPA integrated into IPS's Salesforce platform.
• Cornerstone Preferred ResourcescoreGTM or Marketing Partner · 1 January 2022Cornerstone Preferred Resources partnered with IPS to implement Transparency+ for NSA compliance, claims processing, and advanced EOBs. Cornerstone approached IPS in November in preparation for 2022 No Surprises Act requirements. IPS provided Cornerstone with the ability to bring their clients' plans into full compliance with the Act's multi-faceted elements.
• Hawaii Mainland Administrators, LLCminorGTM or Marketing Partner · 1 January 2021Hawaii Mainland Administrators signed a contract for Transparency+ to achieve NSA compliance and advanced EOB capabilities. IPS had the solution operational in an average of 60 days, addressing the client's urgent need to prepare for 2022 transparency requirements.
• VālenzcoreGTM or Marketing Partner · 1 January 2021IPS partnered with Vālenz, an Arizona-based healthcare company, to integrate Transparency+ into the Vālenz ecosystem. The partnership supports Vālenz's health plan, TPA, and self-insured clients in achieving NSA compliance and providing transparency for medical costs. IPS implementation was completed in approximately 60 days.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• HealthEdge: HealthEdge provides a SaaS claims administration and care management suite (HealthRules Payor, GuidingCare) for health plans and TPAs. It is the closest scaled direct competitor to IPS's Encompass+ within the U.S. payer claims-administration market.
• Cognizant TriZetto: TriZetto offers Facets and QNXT core claims and benefits-administration platforms widely used by U.S. health plans and TPAs. It competes head-to-head with IPS for new TPA and ASO core-system replacement deals.
• Edifecs: Edifecs is a healthcare interoperability and X12 EDI / compliance platform serving payers and TPAs, including HIPAA transaction and value-based care compliance. It is directly comparable to the Transparency+ compliance layer IPS offers.
• Benefitfocus: Benefitfocus sells a benefits-administration and employee-engagement platform used by health plans, TPAs, and large employers. It overlaps with IPS on TPA-facing administration workflows and consumer engagement for benefits.
• PlanSource: PlanSource is a cloud benefits-administration and enrollment platform serving employers, TPAs, and benefit brokers. It competes for the same mid-market employer-sponsored plan workflows that IPS Encompass+ targets through TPAs and ASOs.
• Zelis: Zelis provides healthcare payments, pricing, and analytics for payers, TPAs, and providers, including claim cost and transparency analytics directly adjacent to IPS's provider-data and transparency modules.

Broad incumbents

• WEX Health: WEX Health is a large incumbent offering HSA, COBRA, and consumer-directed benefit administration plus payments infrastructure. It serves the same payer/TPA buyer base as IPS but with a broader portfolio of services.
• HealthEquity (further) via Lumenos / DCAS-like adjacents: WageWorks/HealthEquity-style incumbents combine consumer benefit accounts and TPA-adjacent services. They overlap IPS's payer-administration footprint as a larger, adjacent incumbent in the same regulated buyer environment.
• DXC Technology (Healthcare): DXC provides healthcare IT services including claims processing platforms (formerly CSC) for commercial and government payers. It competes with IPS for large payer core-systems modernization mandates.

Emerging players

• Hexure: Hexure builds digital sales and compliance automation for insurance and annuity distribution, with adjacent data-exchange and regulatory-transparency tooling. It is an emerging peer intersecting with IPS on regulated healthcare/insurance data flows.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/integrated-payor-solutions

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Integrated Payor Solutions