Direct Substantiation for TPAs

Eliminate pay-and-chase for Truemed transactions with automated LMN substantiation.

Overview

The Truemed Direct Substantiation API eliminates most pay-and-chase scenarios for Third Party Administrators. Submit settled network transactions to Truemed and receive complete substantiation data—LMNs, receipts, and IRS-compliant diagnosis categories—without any member involvement.

The Pay and Chase Problem

FSA transactions for health and wellness purchases require substantiation. Without automation, your team must:

1. Contact the member to request documentation
2. Follow up repeatedly if they don’t respond
3. Process the documentation when received
4. Escalate to employers if still unsubstantiated by year-end

This “pay and chase” process costs $5-25 per instance in administrative burden. For TPAs processing thousands of these transactions, the costs add up quickly.

How Truemed Changes This

Truemed qualifies members at checkout and generates LMNs before the transaction settles. When you receive a Truemed transaction, the substantiation documentation already exists.

Your new workflow:

1. Transaction settles through normal card network
2. Submit transaction to Truemed (API or portal)
3. Receive substantiation data instantly

No member contact. No follow-up. No year-end scramble.

What You Receive

For each matched transaction, Truemed returns:

Unmatched transactions are simply omitted from the response—no error handling required on your end.

Integration Options

Choose the approach that fits your team’s capabilities and volume.

Option A: API Integration

Best for: TPAs with engineering resources who want fully automated substantiation

The API integration provides real-time, programmatic access to substantiation data:

• Submit batches of up to 100 transactions per request
• Receive instant responses with all substantiation data
• Integrate directly into your claims adjudication workflow
• Fully automated—no manual intervention required

How it works:

Implementation effort: Requires engineering time to build the integration, but eliminates all ongoing manual work.

Option B: Portal Dashboard

Best for: Smaller TPAs, or teams evaluating before committing to API development

The portal provides a simple web interface for substantiation:

• Upload a CSV file of settled transactions
• Truemed matches against our records
• Download substantiation data and documents
• No engineering work required, minimal ongoing ops work

How it works:

1. Export your settled Truemed transactions to CSV
2. Log into the Truemed TPA Portal
3. Upload your CSV file
4. Download the matched substantiation data and documents
5. Process in your system

Implementation effort: Minimal—just train one team member on the portal workflow. Ideal for getting started quickly or for lower-volume TPAs.

The ongoing ops work for the portal is extremely small compared to the current pay-and-chase process—a few minutes of uploading and downloading files versus hours of member outreach and follow-up.

If you’re unsure which integration option is best, we encourage you to start with our portal approach and then move to the API integration as volume grows.

ROI Calculation

Estimate your savings from Truemed Direct Substantiation:

Monthly Truemed transactions × $5-25 per pay-and-chase = Monthly savings

For example, a TPA processing 500 Truemed transactions per month:

• Low estimate: 500 × $5 =$2,500/month saved
• High estimate: 500 × $25 =$12,500/month saved

This doesn’t include the compliance benefits and improved member experience.

Getting Started

1. Contact us at tom@truemed.com to discuss your needs
2. Choose your integration option (API or Portal)
3. Receive credentials and access to sandbox environment
4. Implement and test with sample transactions
5. Go live and start auto-substantiating

We provide implementation support throughout the process. Most TPAs are live within 1-2 weeks for portal integration, or 2-4 weeks for API integration.

Questions?

Contact tom@truemed.com for integration support.