25
years in outsourced software
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Custom Software for HMOs & Health Insurers
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From Spec to Production-Ready Claims Software — in Weeks.
Health Insurance Software Where Every Claim Is Adjudicated and Paid
Cashless authorization, claims adjudication, and compliant disbursement aren't features you bolt onto a generic claims system after launch — they're the operational core of a health insurance business. BlastAsia builds custom TPA and claims administration software for Philippine HMOs and health insurers where PhilHealth, BIR, and Data Privacy Act compliance are engineered in from day one.
BlastAsia at a Glance
25
YEARS ENGINEERING EXCELLENCE
10+
COUNTRY CLIENT BASE
3
LINES — MEDICAL, DENTAL, VETERINARY
Cashless
POINT-OF-CARE AUTHORIZATION
PhilHealth · BIR Withholding · Data Privacy Act 2012 (NPC) · PESONet
No commitment. Just talk to our consultant!
THE PROBLEM
Why HMOs and Health Insurers Outgrow Generic Claims Systems
Health insurance TPA operations sit at the intersection of clinical review, claims administration, and regulatory compliance — three disciplines most generic claims platforms handle separately, badly, or not at all. The result is a claims operation held together by phone calls, manual review, and spreadsheets, right at the moment members and providers need speed and certainty most.
Cashless authorization verified by phone, not in real time
Member eligibility, coverage limits, and provider network status checked by phone, fax, or email at the point of care — delaying patient treatment while a provider waits for authorization that a real-time system could confirm instantly.
Claims adjudication that's slow, inconsistent, and hard to audit
Claims reviewed manually against policy terms with no systematic fraud detection — creating inconsistent outcomes, overpayment risk, and delayed reimbursement for providers and members alike.
Clinical pre-authorization with no structured workflow
Treatment approvals requiring clinical review handled ad hoc, with no system to route cases, track turnaround, or maintain a consistent standard — creating delays for both patients and providers.
Disbursement and compliance reporting fragmented across systems
BIR withholding, PhilHealth case-rate logic, and provider payouts calculated and reconciled in disconnected spreadsheets and systems — creating compliance risk and slow, error-prone payment cycles.
PRE-BUILT SOLUTION
InsureOS: The Pre-Built TPA & Claims Platform
Before scoping a fully custom build, consider starting from a proven base. InsureOS is BlastAsia's pre-built third-party administration platform for Philippine HMOs and health insurers — purpose-built for cashless claims, adjudication, and compliant disbursement.
HEALTH INSURANCE & TPA · PHILIPPINES
InsureOS
Every claim, adjudicated and paid.
OPTIMIZED FOR
Philippines (primary)
PhilHealth & BIR compliance
Medical, dental & veterinary lines
InsureOS is a modern third-party administration platform for Philippine HMOs and health insurers. It handles cashless Letter of Authorization (LOA) processing, AI-assisted claims adjudication, clinical pre-authorization, coordination of benefits, fraud detection, and BIR-compliant disbursement — across medical, dental, and veterinary lines. PhilHealth case-rate logic, BIR withholding, and Data Privacy Act compliance are built into the workflow, not bolted on as a reporting afterthought.
THREE WAYS TO GO LIVE
PATH
WHAT IT INCLUDES
TIMELINE
Out-of-the-Box
Brand it, host it, go live — standard configuration, your logo and domain
Under a week
Configured
Extend with your specific benefit plans, provider network, and reporting requirements
A few weeks
Custom Build
BlastAsia builds additional modules or a fully bespoke TPA platform using the Xamun Software Factory
Project-scoped
KEY MODULES
✓
Cashless LOA processing — real-time eligibility and coverage verification at point of service, replacing phone and fax authorization
✓
AI-assisted claims adjudication — claims reviewed against policy terms and coverage rules with AI assistance, reducing manual review time
✓
Clinical pre-authorization — structured workflow for treatment approvals requiring clinical review, replacing ad hoc manual processes
✓
Coordination of benefits — automated reconciliation when a member has multiple coverage sources
✓
Fraud detection — pattern analysis across claims to surface suspicious activity before payout
✓
BIR-compliant disbursement — provider payouts calculated and processed with BIR withholding built in
✓
PhilHealth case-rate logic — case-rate calculations aligned to PhilHealth's schedule, built into claims processing
✓
Multi-line support — medical, dental, and veterinary insurance lines on one platform
✓
Role-based operations — distinct workspaces for claims processors, medical reviewers, finance, and provider relations
WHY HMOS & HEALTH INSURERS CHOOSE BLASTASIA
Why HMOs & Health Insurers Choose BlastAsia
BlastAsia has been building business-critical software for regulated, high-stakes operations for 25 years. Here's what that means for an HMO or health insurer looking for a technology partner that understands the compliance complexity of Philippine health insurance TPA operations.
Purpose-Built for Philippine Health Insurance TPA — Not a Generic Claims System
InsureOS was designed from the ground up for cashless LOA processing, PhilHealth case-rate logic, and BIR-compliant disbursement. These aren't features grafted onto a generic claims platform. They're the engineered core of a Philippine-specific TPA system.
Cashless at the Point of Care
Eligibility and coverage verification happen in real time, not over the phone — so treatment isn't delayed while a provider waits for authorization a system could confirm instantly.
You Own the Code — No Annual License, No Vendor Dependency
Every platform BlastAsia delivers is owned outright by the client. Full source code, deployed on your own infrastructure, with no recurring license fees and no dependency on a vendor's pricing decisions or product roadmap.
AI-Assisted, Not AI-Replaced
Claims adjudication and fraud detection are AI-assisted, with clinical and compliance review retained in the workflow — speeding up routine decisions without removing human oversight where it matters.
PhilHealth & BIR Compliance Built In, Not Bolted On
Case-rate logic, withholding calculations, and disbursement compliance are part of the core claims workflow — not a separate reporting module reconciled after the fact.
25 Years of Business-Critical Software Delivery
BlastAsia has built and implemented business-critical software for global enterprises for 25 years. InsureOS pairs that engineering pedigree with the Xamun Software Factory's AI-powered delivery model — bringing enterprise software rigor at a speed and cost that fits an HMO's business.
COMPLIANCE
Compliance Is Built Into Claims Processing, Not Reconciled After Payout
Philippine health insurance TPA operations carry real compliance requirements — PhilHealth case-rate alignment, BIR withholding on provider disbursements, and Data Privacy Act obligations around sensitive member health data. Software that treats these as a reporting afterthought creates exposure that compounds with every claim processed.
InsureOS builds PhilHealth and BIR compliance into the claims and disbursement workflow itself — not as a separate reconciliation step. Custom TPA software BlastAsia builds follows the same compliance-by-design principle, regardless of jurisdiction.
PhilHealth Case Rates
BIR Withholding
Data Privacy Act 2012 (NPC)
PESONet Disbursement
Cashless LOA Processing
WHO WE BUILD FOR
HMOs & Health Insurers We Build For
BlastAsia's health insurance TPA practice serves HMOs, health insurers, and plan administrators across the Philippine market — from established HMOs managing large provider networks to corporate plan administrators running self-funded benefit programs.
CORE SEGMENT
HMOs & Health Insurers (Philippines)
Philippine HMOs and health insurance companies needing cashless claims processing, adjudication, and compliant disbursement across medical, dental, and veterinary lines.
CORE SEGMENT
Third-Party Administrators (TPAs)
TPAs managing claims processing and provider network administration on behalf of insurers or self-funded employer plans.
CORE SEGMENT
Corporate HMO Plan Administrators
Companies administering self-funded or corporate HMO plans for their employees — needing the same claims and compliance infrastructure without building it in-house.
ALSO SERVED
Healthcare Provider Networks
Hospital and clinic networks that need to integrate with HMO claims and authorization systems from the provider side.
ALSO SERVED
Veterinary Insurance Providers
Pet insurance and veterinary benefit providers needing claims infrastructure adapted from the same multi-line platform.
ALSO SERVED
InsurTech Platforms Serving the Philippine Market
InsurTech companies building health insurance products for the Philippine market — needing engineering partners experienced in PhilHealth and BIR compliance.
OTHER SOLUTIONS
Other Health Insurance Software We Can Build for You
InsureOS covers cashless claims and TPA operations for most Philippine HMOs and health insurers. For organizations with requirements beyond the pre-built platform, BlastAsia designs and builds custom health insurance software from the ground up.
Provider Network Management Platforms
Custom platforms managing provider contracting, credentialing, and network directory data for HMOs and health insurers.
Member Self-Service Portals
Custom member portals for claims status, benefit lookup, provider search, and digital ID cards — reducing inbound call volume.
Employer Group Benefits Administration
Custom platforms for employer groups managing enrollment, eligibility, and benefit plan administration for corporate HMO accounts.
Actuarial & Pricing Tools for Health Insurance
Custom actuarial modeling tools bringing rating algorithms and claims experience data into a governed, auditable platform.
Multi-Country TPA Compliance Engines
Custom rule engines for TPAs operating claims administration across multiple regulatory jurisdictions beyond the Philippines.
Telehealth & Claims Integration Platforms
Custom platforms connecting telehealth consultation data directly into claims and authorization workflows.
Powered by Xamun.AI
The Tool We Use to Build Custom Health Insurance Software
Health insurance claims software has zero tolerance for ambiguity — a misconfigured case-rate rule or an incorrectly modeled coordination-of-benefits scenario doesn't produce a bug report, it produces an incorrect payout or a compliance finding. Every rule, every gate, and every disbursement calculation needs to be precisely specified before any code is written.
The Xamun Software Factory's spec-first methodology means every claims rule, compliance requirement, and disbursement calculation is precisely defined and agreed before development begins. InsureOS itself was built this way — its cashless LOA workflow and PhilHealth case-rate logic are the product of that discipline, not features bolted onto a generic claims system afterward.
The result is health insurance software that is faster to deliver, safer to extend, and built with full source code ownership — no vendor lock-in, no black-box adjudication engine, and no dependency on a SaaS provider's roadmap to get the features your business needs.
80%
Codebase Auto-Generated
AI generates routine code so engineers focus on adjudication logic, compliance rules, and disbursement accuracy.
2wk
Sprint Cadence
Working, tested software every two weeks — claims logic tested continuously, not discovered broken at go-live.
Spec-First
Claims Rules Defined Before Code
Every case-rate rule and compliance requirement specced before development — no adjudication gaps discovered after payout.
100%
Code Ownership
Full source code delivered to you. Deployed on your infrastructure. No vendor lock-in, no black-box adjudication engine.
