One platform connecting every payer to every provider — processing claims, managing networks, and making healthcare financing actually work.
The Gap We Fill
Payers exist. Providers exist. But the operational infrastructure connecting them — claims, contracts, payments — has never been built. Until now.
Every employer, insurer, and donor program runs its own fragmented system. There's no shared standard, no common platform, and no visibility across payers.
Facilities face unpredictable payment timelines, no standardized pricing, and no referral coordination — making it impossible to plan or improve care delivery.
Without utilization controls, fraud detection, or performance incentives, healthcare spend in Ethiopia runs largely unchecked — harming payers and patients alike.
Our Identity
This distinction matters. TPA+ is infrastructure, not a competitor to insurers or providers. We exist to make the whole system work better.
Core Services
Every service we offer falls into one of two functions — both essential, both delivered through a single digital platform.
End-to-end claims management for payer organizations — faster, cheaper, and more accurate than any in-house solution.
Building and governing Ethiopia's highest-quality provider network — contracted, priced, and held accountable.
Payment Innovation
A hybrid payment model designed to align provider incentives with quality, efficiency, and prevention — at every level of care.
The Platform
A purpose-built digital platform — not an off-the-shelf product. Designed for scale, interoperability, and the operational realities of the Ethiopian market.
Automated adjudication rules with configurable payer-specific logic
Real-time claim submission, tracking, and payment status for facilities
Enrollment, verification, and benefit management at point of care
Pattern detection, utilization analytics, and audit trail management
Open APIs connecting client HR, ERP, and HMIS systems seamlessly
Live reporting for payers, providers, and internal operations teams
Who We Serve
Starting with the most ready institutional clients — and building toward national coverage as credibility and scale grow.
Companies spending millions on employee health benefits with no visibility into cost, utilization, or provider quality.
Primary clientInsurance companies that need outsourced TPA operations and an accredited provider network — without building it themselves.
Primary clientGlobal health programs operating parallel, siloed systems that need a trusted operational partner with proven infrastructure.
Primary clientImplementation
Three deliberate phases — built around evidence, trust, and scale. Each phase unlocks the next.
Regulatory
By design, TPA+ avoids insurance licensing requirements while remaining fully compliant with health services regulations.
Registered as a health management and services company — not an insurer — under Ethiopian commercial law.
Clear separation from risk-bearing activities means TPA+ operates without triggering insurance regulatory requirements.
Platform design built around patient data privacy and financial reporting standards from the ground up.
Separate engagement protocols for work with public providers — with relevant Ministry of Health coordination.
Get Involved
The first organizations to partner with TPA+ will shape how this platform is built. If you're an employer, insurer, donor program, or investor — let's talk.
Concept stage. This platform is in active development. Early partners will directly influence the pilot design, provider network geography, and technology priorities.