ProTPL is a real-time, point-of-sale cost avoidance service from Syrtis Solutions. It identifies primary commercial coverage on your members, so the claim can be routed to the responsible payer before an improper payment is ever made. It is built to prevent improper payments rather than recover them after the fact.

Pay-and-chase means paying a claim in error and then trying to recoup the money afterward, through investigations, recovery notices, and disputes. Traditional recovery approaches are inefficient and expensive, and they produce recovery rates of less than 17% of the dollars paid in error. Prevention identifies the other coverage before payment, which avoids the cost entirely and eliminates the downstream administrative burden that recovery creates.

No. ProTPL supplements your current infrastructure rather than replacing it. It works alongside the current systems, carrier feeds, and batch matching processes, and closes the specific gaps those systems structurally cannot reach. There is no need to change existing vendor contracts.

ProTPL accesses the nation’s largest commercial master patient index, representing over 300 million covered individuals nationwide, using industry-standard transactions. Rather than relying on member self-disclosure from months earlier, stale data lakes, or delayed batch feeds, it verifies coverage on the day the claim is processed. That timing is what surfaces coverage other methods cannot.

Test data demonstrates that between 6% – 13% of all claims submitted under payer of last resort health plans, excluding Part D, are found to have other pharmacy coverage. Through a prospective cost avoidance solution, claims with other coverage are identified in real-time at the pharmacy point of sale.

In addition to cost avoidance, this information is used to retrospectively recover pharmacy claims previously approved, as well as to identify additional medical dollars that can be recovered both retrospectively and prospectively. The program complies with all federal TPL requirements and reduces inefficient pay and chase methodologies.

No. Syrtis processes transactions in sub-seconds and integrates seamlessly into existing pharmacy workflows. There is no disruption to the provider or patient experience.

ProTPL deploys through lightweight, standards-based connectivity, not a core system replacement. Typical implementation runs 6 to 10 weeks: 4 to 6 weeks for proof of concept, file formatting, and testing; 1 to 2 weeks of pilot operations; and 1 to 2 weeks to full production. This contrasts sharply with the 18 to 36 month timelines typical of major claims system replacements.

Verification operates independently of your core claims processing. If a file exchange is ever interrupted, claims simply continue through your existing workflows. Member access and provider payment continuity are never affected.

ProTPL identifies previously unknown primary medical and pharmacy coverage on members submitting claims.

Recovery workflows do not reverse an improper payment designation once it has occurred. Only prevention-based discovery at the point of claim adjudication addresses that exposure, because the payment is never made improperly in the first place. For plans focused on improper payment rates and audit readiness, prevention changes the underlying number rather than chasing it afterward.

Yes. Syrtis exchanges data through secure file transfer and ProTPL operates under HITRUST CSF certification, the recognized standard for safeguarding protected health information. Coverage verification uses industry-standard HIPAA-compliant transactions.

Across Health Plan populations, ProTPL has identified that between 1.5% and 8% of submitted claims have other coverage. During 2025, Syrtis processed nearly 500 million coverage inquiries and identified approximately 130 million previously unknown pharmacy coverages and almost 50 million previously unknown medical coverages.

The first step is a free quantitative claims analysis. Syrtis reviews your claims data and shows you, in empirical terms, exactly how much your organization can save before any commitment. See how much you can save. See how soon.