A licensed TPA since 1982, SOMI has an enviable track record in the performance and management of hundreds of self-funded plans. Accuracy, flexibility and customer-centered values make up the foundation upon which all other processes stem.

SOMI’s accuracy and performance record is exemplary.  Our average claim cost per employee consistently falls below the national average by 10%-20%.  We credit our success, in part, to our audit and management procedures.  

As your TPA, we can do it all:

  • Design and build your plans on our claims systems
  • Manage and contract with all plan vendors such as PPOs, PBM, Stop Loss, UR, specialty services
  • Assist in rate and financial guidelines for appropriate funding
  • Handle all enrollment and eligibility loads and feeds
  • Draft legal plan documents and on-going amendments and plan changes
  • Produce ID cards and required forms
  • Coordinate transition from current administrator
  • Perform enrollment meetings
  • Implement legal updates and legislative requirements
  • Integrate claims processing with Ingenix and PPO partners
  • Perform EDI transmission and receipt
  • Integrate with and monitor PBM
  • Provide trigger diagnosis reporting and disease management program
  • Manage coordination of benefits
  • Prepare and manage appeals
  • Provide maternity and specialty care management
  • Present monthly claims and analytical reports
  • Offer multiple funding options
  • File 1099s
  • Prepare 5500 tax forms