InsureOS
View live demo Book a walkthrough
Third-party administration · Built for the Philippines

Every claim, adjudicated and paid — at the speed of care.

InsureOS runs your entire TPA lifecycle — cashless LOA, intake, clinical pre-auth, AI-assisted adjudication, fraud screening and BIR-compliant payout — with PhilHealth case rates, withholding tax and Data Privacy guardrails baked in. Enterprise capability, without the enterprise price tag or a two-year rollout.

Book a walkthrough → Explore the live demo
Live UAT environment · PhilHealth · BIR WHT · PESONet · ICD-10
InsureOS program performance dashboard showing members, claims settled and pre-auth SLA compliance
✓
Pre-auth SLA 90.6%
Within statutory turnaround
₱
Claim settled
WHT applied, ledger updated
Compliant by design with PhilHealth case rates BIR withholding & OR Insurance Commission RA 10173 Data Privacy ICD-10 coding RBAC & MFA audit trail
The cost-to-feature problem

Global claims suites are overkill. Spreadsheets-and-email are a liability. InsureOS is the fit.

Philippine HMOs and TPAs are forced to choose between million-peso international claims platforms that have never heard of a PhilHealth case rate or a BIR official receipt, generic health SaaS that doesn't speak the local regime, or spreadsheets and email threads that miss SLA and fall apart at the first Insurance Commission examination. InsureOS is purpose-built for the middle — real adjudication, real compliance and a real audit trail, right-sized for a TPA and owned outright rather than rented.

1 lifecycle
Intake → pre-auth → adjudication → fraud screen → disbursement, in one system
3 lines
Medical, dental and veterinary pre-authorization in a single clinical queue
Every channel
Web upload, mobile photo and partner-API claim intake, audited against SLA
Weeks, not years
Go live in a quarter — no multi-year core claims-system implementation
One platform, the whole book of business

Everything a Philippine TPA actually needs

Not a generic CRM with a claims bolt-on. Every module is shaped around how regulated health administration works here.

AI-assisted adjudication

The workbench proposes a settlement — PhilHealth case rate, senior/PWD discount, VAT exemption and co-pay — while an AI assistant scores confidence, validates documents and checks ICD-10 consistency. The adjudicator decides; the math is done.

OCR intake & document audit

Claims arrive from web, mobile photo or partner API. OCR extracts fields with a confidence score, verifies BIR official receipts and indexes ICD-10 — low-confidence values flagged before adjudication.

Clinical pre-authorization

Medical, dental and veterinary LOA requests in one queue with urgency and aging trackers — plus pluggable clinical decision support, so reviewers approve the right cases first, on guideline.

Coordination of benefits

Determine payer sequencing, apply PhilHealth-first offsets and calculate residual member liability for multi-coverage claims — duplicate and secondary-payer logic built in.

Fraud, waste & abuse detection

Every finding is scored — duplicate claims, excessive frequency, provider outliers — and routed for investigation before a single peso goes out the door.

Finance, WHT & reconciliation

Settle approved claims against the corporate escrow balance with BIR withholding tax per payee, bulk disbursement over PESONet, and carrier-funds reconciliation — every statement audit-ready.

Member self-service

Members request cashless LOAs, file reimbursement claims with their receipts, and track every Explanation of Benefits — with appeals — from an installable web app, no app store needed.

Provider & corporate portals

Providers submit direct billing, GOP and inpatient claims with WHT auto-calculated; corporate HR runs enrollment and roster; carriers watch program performance — each in its own workspace.

Workflow rules & SLA engine

Configure adjudication rules, auto-adjudication thresholds, escalations and SLA clocks without a developer — and watch turnaround and queue metrics in operational dashboards.

RBAC, MFA & audit reporting

Nineteen role-scoped workspaces, MFA enforcement and an access-control console — consolidating logs, overrides, exceptions and policy deviations into regulator-ready compliance reports.

See it in action

Real screens from a real, running product

Not mockups. Every screen below is live in the InsureOS demo environment today.

Adjudication

Decisions backed by AI, not guesswork

The adjudication workbench pulls the claim, the member's maximum benefit limit and the statutory math into one view — then an AI assistant proposes a net payout and tells you why, so the adjudicator confirms a decision instead of computing one.

  • AI confidence score with explainable rationale
  • PhilHealth case rate, senior/PWD, VAT & co-pay applied
  • Document validity, ICD-10 consistency & duplicate checks
InsureOS claims adjudication workbench with AI assistant and PhilHealth statutory deductions
Clinical pre-authorization

Medical, dental and veterinary — one queue

Every pre-auth request lands in a single review queue with provider, corporate client, urgency and an aging/SLA tracker. Reviewers triage by deadline and risk, and pluggable decision support keeps approvals on guideline.

  • Separate queues for medical, dental, pet & provider pre-auth
  • Live aging tracker against the SLA clock
  • Clinical decision support on every LOA
InsureOS clinical pre-authorization queue with medical, dental and veterinary tabs
Fraud, waste & abuse

Catch the bad claim before you pay it

Detection scores every flagged claim and ranks it by risk — duplicates, excessive frequency, provider outliers — with a clear worklist so investigators spend their time where the money actually leaks.

  • Risk-scored findings with critical/high/medium tiers
  • Duplicate-claim & provider-outlier detection
  • Route suspicious cases straight to investigation
InsureOS fraud, waste and abuse detection dashboard with risk-scored findings
Member experience

A portal your members will actually use

A clean, installable web app where members see their available balance, request a cashless LOA, file reimbursements with their BIR receipts and track every claim decision — no phone calls, no paper chase.

  • Cashless LOA with live benefit balance & co-pay
  • Snap-and-file reimbursement with receipt rules built in
  • Explanation of Benefits with one-tap appeals
InsureOS member mobile app showing cashless LOA request and benefit balance
Watch the demos

See InsureOS in action

Two walkthroughs — one from the member's seat, one from the back office.

Member experience

Cashless care, clean reimbursements — from your phone

The full member journey: request a cashless LOA with your benefit balance in view, file a reimbursement with your receipts, and track every claim decision. Mobile-first, no app store needed.

Platform walkthrough

Intake to payout — every workspace, end to end

Program dashboard, claims ingestion, OCR extraction, AI-assisted adjudication, clinical pre-auth, fraud screening and BIR-compliant disbursement. Nine purpose-built workspaces, wired in from day one.

How InsureOS compares

The winning balance of cost and capability

Stacked against the ways Philippine HMOs and TPAs run their claims today.

Capability InsureOS Purpose-built for PH Global claims suite
(international vendors)		 Generic health SaaS
(foreign platforms)		 Spreadsheets / email
PhilHealth case-rate adjudication ●  Built-in ✕  Custom build ✕  Not localized ✕  Manual
AI-assisted settlement & confidence scoring ●  Native ◑  Add-on ◑  Varies ✕  None
BIR withholding tax & official-receipt audit ●  Built-in ✕  Not localized ✕  No ◑  Manual
Clinical pre-auth: medical, dental & veterinary ●  One queue ◑  Medical only ◑  Varies ✕  None
OCR intake & ICD-10 indexing ●  Built-in ◑  Module ◑  Generic ✕  Manual
Fraud, waste & abuse detection ●  Risk-scored ◑  Add-on ◑  Varies ✕  None
Coordination of benefits (PhilHealth-first) ●  Built-in ◑  Configurable ✕  Not localized ✕  Manual
PESONet bulk disbursement & reconciliation ●  Native ◑  Integration project ◑  Custom ✕  Manual
Member & provider self-service portals ●  Included ✕  Separate project ◑  Varies ✕  None
SLA engine & audit-ready compliance reports ●  Built-in ●  Yes ◑  Varies ✕  Error-prone
Time to go live ●  Weeks ✕  12–24 months ◑  Months ●  Immediate*
Source code ownership & white-label ●  You own & rebrand it ✕  Vendor-locked ✕  Vendor's product ◑  Files only
Hosting & data residency control ●  Your infra, any region ◑  Vendor-defined ✕  Vendor cloud only ◑  Your device
Commercial model ●  One-time perpetual licence ✕  Licence + integrator ✕  Recurring per-seat SaaS ◑  Cheap, then costly

● built-in  ·  ◑ partial / requires work  ·  ✕ not available. *Spreadsheets are "free" until the first SLA breach, examination finding, or reconciliation error. Vendor categories are illustrative, not endorsements.

The sweet spot

Maximum capability, minimum overhead

Capability →
Global claims suite
Generic health SaaS
Spreadsheets
InsureOS
Cost / complexity →

Right-sized for PH administrators

HMOs, TPAs, corporate health plans and clinic networks get carrier-grade controls without a carrier-grade budget or headcount.

Live in a quarter, not a saga

Pre-built PhilHealth and BIR logic means you configure benefits and launch — instead of funding a multi-year claims-system integration.

Compliance is the default, not a project

Insurance Commission, BIR, PhilHealth and Data Privacy obligations are wired into the workflow — so you pass examinations because the system kept you on the rails.

Built to scale with the book

From your first hundred claims to multi-line medical, dental and veterinary across corporate and carrier programs — one platform grows with you.

Ownership, not rental

You own your TPA platform — source code and all

InsureOS is not SaaS. Under a source-available license you receive a copy of the source code, brand it as your own, deploy it wherever you choose, and keep full control of your data and your roadmap.

The source code is yours

You receive the complete source under a perpetual license. Read every line, audit it, and never be held hostage to a vendor's roadmap or release cadence.

Brand it entirely as your own

White-label from the ground up — your name, logo, colors and domain across the member app, provider portal and staff console. Ship it to market as your product, not ours.

Host it anywhere

Your cloud, your on-prem data center, your region of choice. No mandatory vendor cloud, no per-seat metering, no usage caps that throttle growth.

Your data never leaves your control

Member PHI and claim records sit in infrastructure you own — making Data Privacy Act (RA 10173) and Insurance Commission data-residency compliance far simpler to demonstrate.

Customize without limits

Modify and extend the platform for your own benefit designs and workflows. The code is yours to evolve — by your team or ours — as the business grows.

Perpetual license

A one-time license to the delivered version, yours to run indefinitely. No subscription that can be switched off, no renewal leverage held over you.

Source-available, not open-source. You get the code for your own internal business use, with the right to brand, host, modify and run it in perpetuity. Reselling it or offering it to third parties as a service is reserved. The full terms are short and in plain English.
Read the license terms →
Built for

Whoever you administer for, InsureOS fits

🏥

HMOs & health insurers

Carriers who need PhilHealth-aware adjudication, SLA control and audit-ready reporting from day one.

📋

Third-party administrators

Intake, pre-auth, adjudication, fraud and payout across multiple corporate and carrier programs.

🏢

Corporate health plans

HR enrollment, roster management and a member portal for self-administered company plans.

🐾

Clinic & multi-line networks

Medical, dental and veterinary providers with direct billing and BIR-compliant payouts.

Who builds & delivers InsureOS

Enterprise software pedigree, delivered at AI speed

InsureOS pairs decades of business-critical engineering with an AI-powered delivery model — so you get depth and speed, not a trade-off between them.

B

BlastAsia Inc.

Implementation partner

For 25 years, BlastAsia has built and implemented business-critical software for global enterprises — bringing deep engineering discipline, domain expertise and delivery rigor to every InsureOS deployment.

  • A quarter-century building global, business-critical systems
  • Enterprise-grade engineering & delivery practices
  • Hands-on, local implementation and support
X

Xamun.ai

AI-Powered Software Factory

Xamun is an AI-powered software factory that brings speed and reliability to commercial software delivery at scale — compressing what once took years into months, without sacrificing quality.

  • AI-accelerated build and delivery
  • Reliability and quality engineered in at scale
  • Faster time-to-market for commercial software

See InsureOS run your claims book

Book a 30-minute walkthrough, or jump straight into the live demo environment and click through it yourself.

Book a walkthrough → Open the live demo