PORTSMOUTH, N.H. a d EAGAN, Mi ., Ju e 25, 2026 (GLOBE NEWSWIRE) — TALON, the leade i healthca e p ice t a spa e cy, a d Sma t Data Solutio s (SDS), a leadi g healthca e p ocess automatio compa y, today a ou ced the ext phase of thei st ategic pa t e ship, b oade i g access to TALON’s U ive sal Rep ice a d UAPA™ (U ive sally Acceptable Payme t Amou t™) tech ology ac oss SDS’s EDI clea i ghouse i f ast uctu e. With the i teg atio al eady i p oductio , the pa t e s a e ow scali g adoptio so that mo e health pla s, TPAs, a d self-fu ded employe s ca apply evide ce-based ep ici g i side thei existi g clea i ghouse wo kflow, without added ope atio al lift.
Healthca e claims p ocessi g has lo g suffe ed f om a fu dame tal i fo matio gap. By the time a claim eaches adjudicatio , the oppo tu ity to apply ma ket-accu ate, evide ce-based p ici g is ofte lost to legacy fee schedules, opaque etwo k co t acts, a d ma ual ep ici g wo kflows. The esult is systemic ove payme t, ep ese ti g a mea i gful sha e of the estimated $500 billio i a ual employe healthca e ove spe d d ive by system opacity.
Today’s domi a t p ici g models compou d the p oblem. Refe e ce-Based P ici g (RBP) p og ams typically ely o Medica e multiples that dive ge f om comme cial ma ket ates a d face g owi g legal a d p ovide – elatio s challe ges. T aditio al etwo k “discou ts” begi f om i flated cha gemaste ates, applyi g eductio s that do ‘t eflect a t ue ma ket-clea i g p ice, d ivi g disputes, bala ce-billi g isk, a d hidde costs. UAPA™ co ects both disto tio s by a cho i g payme t to the p ices p ovide s most commo ly accept, de ived f om the weighted ave age of paye – egotiated ates ac oss ea ly eve y p ovide a d paye co t act i the cou t y.
The TALON–SDS i teg atio closes that gap at the ea liest poi t i the claims data st eam. As the pa t e s exte d the i teg atio to additio al SDS clie ts, mo e paye s a d TPAs gai access to a t a spa e t, defe sible p ice sig al befo e adjudicatio begi s.
The TALON–SDS pathway outes claims submitted th ough SDS’s EDI clea i ghouse i to TALON’s U ive sal Rep ice , which p ocesses EDI 837 t a sactio s via batch SFTP a d etu s ep iced claims usi g UAPA™ ates – o a y ates fo which TALON has co figu ed, i cludi g all paye -published i – etwo k egotiated machi e- eadable files.
Batch EDI 837 ep ici g via SFTP, embedded di ectly i the SDS claims outi g wo kflowUAPA™ evide ce-based ates applied at the clea i ghouse level, eflecti g actual ma ket ates athe tha egotiated fee schedules o legacy UCR be chma ksClaim audit fu ctio ality that flags p ici g a omalies befo e adjudicatioCompatibility with 16+ claims admi ist atio platfo ms al eady i teg ated with TALON’s platfo mSt eamli ed o boa di g that leve ages SDS’s existi g clea i ghouse co ectivity fo ew TALON clie t impleme tatio s
The expa ded i teg atio add esses the most commo a d costly ep ici g challe ges faci g self-fu ded employe s a d thei admi ist ato s:
Replace atio al w ap etwo ks i di ect-to-employe p ovide co t acti g with a ma ket-weighted be chma kP ice out-of- etwo k claims with a t a spa e t, defe sible ma ket ate athe tha Medica e multiples o UCR estimatesSuppla t faili g RBP p og ams with a p ovide -accepted alte ative that imp oves fi st-pass claim accepta ce a d educes bala ce-billi g exposu eExecute full etwo k eplaceme t usi g UAPA™ as the ope ati g be chma k ac oss a employe ‘s e ti e pla desig
TALON is the leade i healthca e p ice t a spa e cy. Fou ded i 2014 a d headqua te ed i Po tsmouth, NH, TALON i ve ted t ue p ice t a spa e cy fo U.S. healthca e co sume s usi g a cloud-based machi e lea i g p ice t a spa e cy platfo m. I 2018, TALON’s platfo m was demo st ated to fede al egulato s a d se ved as the model fo the T a spa e cy i Cove age Rule. Today, TALON is the o ly complia t healthca e t a spa e cy platfo m fully i teg ated f om p e-to-post-ca e, se vi g health pla s, TPAs, a d self-fu ded employe s ac oss the cou t y.
TALON’s ext-ge e atio UAPA™ (U ive sally Acceptable Payme t Amou t) tech ology applies weighted ave age comme cial p ici g data ac oss 400+ paye s to p oduce evide ce-based eimbu seme t ates fo 50+ millio se vices, delive i g the p ici g i tellige ce that makes eal ma ket competitio i healthca e possible.
Lea mo e at
Sma t Data Solutio s (SDS) is a tech ology leade i healthca e p ocess automatio a d i te ope ability, helpi g paye s a d p ovide s digitally t a sfo m ope atio s a d imp ove outcomes. With a AI- ative platfo m powe i g solutio s i cludi g Digital Mail oom, Clea i ghouse, I tellige t Medical Reco ds, a d P io Autho izatio Automatio , SDS pa t e s with mo e tha 500 healthca e o ga izatio s, p ocessi g hu d eds of millio s of EDI-d ive t a sactio s a ually fo TPAs, paye s, a d p ovide s to st eamli e complex p ocesses a d build a mo e co ected healthca e ecosystem. SDS is HITRUST-ce tified, CAQH CORE-complia t, a d EHNAC-acc edited.
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