Transcarent Experience Store Adds Payment Integrity with Bluespine

Single-platform approach supports improved access to high-quality health and care while safeguarding plan performance and integrity

SAN FRANCISCO & NEW YORK--(BUSINESS WIRE)--Transcarent, the One Place for Health and Care™, today announced the launch of a new payment integrity category in the Transcarent Experience Store, through a partnership with Bluespine. The new category is designed to help employers address overbilling and improper payments to curtail rising healthcare costs through industry-leading, AI-enabled solutions.

An estimated 3 percent to 10 percent of total U.S. healthcare spending is attributable to fraud, waste, and abuse—representing more than $300 billion annually^[1]. For self-insured employers, these dollars are paid directly from plan assets, placing them within the scope of fiduciary responsibility under the Employee Retirement Income Security Act (ERISA). ERISA requires plan fiduciaries to act prudently and solely in the interest of plan participants and beneficiaries, safeguard plan assets, and ensure that payments are consistent with plan terms.

Today, many employers lack independent, comprehensive validation of medical and pharmacy claims against their specific Summary Plan Documents (SPDs), coverage exclusions, negotiated rates, and carrier billing guidelines. Traditional audit methodologies that rely on generic or manually configured rules are typically periodic and sample-based, limiting visibility to a small portion of the total spend, while leaving ongoing financial leakage unaddressed, creating both financial and governance risk.

“Employers are under increasing pressure to control costs while demonstrating rigorous fiduciary oversight,” said Snezana Mahon, PharmD, President, Transcarent. “By expanding the Transcarent Experience Store to include Payment Integrity solutions, Transcarent helps employers increase confidence in their ability to effectively administer claims across the full healthcare lifecycle. Bluespine’s ability to validate the accuracy of healthcare billing provides employers with a more comprehensive strategy for controlling healthcare costs.”

Bluespine, an AI-driven health technology company focused on eliminating medical and pharmaceutical overbilling, is now available to employers through the Transcarent Experience Store. Transcarent helps employers reduce healthcare spending by guiding Members to high-quality, high-value care earlier in the care journey, which helps avoid unnecessary procedures, complications, and downstream costs. Bluespine complements this approach by ensuring that the care delivered is billed accurately and in accordance with each employer’s specific plan coverage.

“As regulators and employers alike focus more closely on billing accuracy, waste reduction, and fiduciary accountability, payment integrity is no longer a niche compliance function, it’s a top priority and core business capability,” added David Talinovsky, CEO of Bluespine. “Partnering with Transcarent allows us to bring our AI-powered, evidence-based approach to a broader audience of self-insured employers who are ready to move from reactive ‘pay-and-chase’ models to proactive, ongoing prevention and recovery.”

Unlike traditional audits that review limited samples of claims, Bluespine analyzes 100 percent of medical and pharmacy claims using a proprietary AI platform purpose built for medical coding validation and the enforcement of plan design coverage. By performing employer-tailored claim reviews that align with an employer’s SPDs, exclusions, and carrier billing guidelines, Bluespine identifies overpayments, policy violations, billing errors, and contractual discrepancies that are often missed by legacy approaches.

Bluespine’s platform supports both prepayment review and post payment recovery, helping employers prevent financial leakage before claims are paid while also recovering unwarranted charges that have already been incurred. Every identified issue is supported by clear documentation tied directly to plan language or billing guidelines, enabling streamlined recovery through TPAs and carriers without disrupting member experience or requiring employer involvement.

The addition of the payment integrity category is part of Transcarent’s broader strategy to curate a best-in-class ecosystem of partners that address the full spectrum of healthcare cost and experience challenges. Experience Store solutions are selected to help employers reduce unnecessary spending, improve transparency, and deliver better outcomes for Transcarent Members.

To learn more about the Payment Integrity category or Bluespine’s offering, visit the Transcarent Experience Store.

About Transcarent

Transcarent is the One Place for Health and Careᵀᴹ, bringing medical, pharmacy, and point solutions together with the WayFindingᵀᴹ experience, the first and only agentic AI-powered health and care platform for health consumers. Our WayFinding experience, paired with transparent and consumer-driven pharmacy care, 2nd.MD expert medical opinions, and virtual primary care, works seamlessly with comprehensive Care Experiences – Cancer Care, Surgery Care, and Weight Health – to support people with all of their health needs, simple or serious. More than 1,700 employers, health plans, and health systems rely on us to provide benefits navigation, clinical guidance, and care delivery for 21 million Members. For more information, visit transcarent.com, and follow us on LinkedIn.

About Bluespine

Bluespine is an AI-powered payment integrity platform built for self-insured employers. The company provides evidence-backed, employer-tailored reviews of medical and pharmaceutical claims to detect overbilling and improper payments before they become financial or compliance risks. As an authorized, independent partner to leading US carriers, working alongside TPAs and PBMs, Bluespine applies plan-specific rule sets and continuous claims review to validate payments against employer plan terms without disrupting member experience. By delivering audit-grade documentation, measurable cost savings, and strengthened fiduciary oversight, Bluespine helps employers improve financial stewardship, enhance claims accuracy, and protect plan assets with greater transparency and accountability.

^[1] NHCAA