Real-Time Eligibility Determination

The Problem

TPAs and ASO providers receive 834 files monthly or quarterly, creating a 30-90 day lag between termination and system update. Claims process runs on older data, paying benefits to employees who no longer qualify. Audits catch the overpayments weeks later. Manual file uploads and custom integrations with each employer's payroll system consume months of engineering time.

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How It Works

1. Stream employee status events - Receive real-time notifications when employment status, hours, or dependent data changes through Bindbee webhooks.
2. Check eligibility instantly - Query the unified Employee and Benefits APIs to confirm current eligibility before claims adjudication.
3. Block ineligible claims - Reject or hold claims for terminated employees before payment processes.
4. Reduce overpayment audits - Catch eligibility changes within hours instead of weeks.