How it works
A deliberate path from first conversation to live review
Every engagement is a series of separate decisions. You choose whether each next step is worth taking, and your organization keeps claim and payment authority throughout.
The engagement
Five phases, each its own decision
No phase promises findings, savings, or a fixed delivery date. Each one ends with a clear choice about what, if anything, comes next.
- 1
Discovery
Confirm the products in scope, the claim decisions that need attention, and who owns data authority and the final payment decision.
- 2
Historical diagnostic Optional
A bounded review of already-paid claims under an agreed scope. The report states the checks completed and any data gaps; a valid result can include no confirmed error.
- 3
Implementation
A separate decision with its own scope, milestones, and acceptance criteria: file contracts, plan configuration, integration, and partner testing.
- 4
Shadow or active operation
Run alongside your process to compare results, or review claims before payment. You choose the mode and record the authorization for it.
- 5
Ongoing service
Regular review of findings, accepted corrections, confirmed payment outcomes, and exceptions, reported as separate measures.
The operating boundary
You decide. Trestl checks and shows its work.
Responsibilities are agreed and written down before live data moves.
| Area | Your organization | Trestl |
|---|---|---|
| Authority and policy | Identify the authorized entities, products, policy interpretation, and final decision owners. | Confirm the agreed scope and apply your instructions consistently. |
| Source data | Provide approved claims and reference data and explain what it means. | Validate the agreed file contract and record intake and processing exceptions. |
| Findings | Review exceptions and decide the action under your process. | Present supported findings with their evidence and record the review. |
| Payment outcomes | Identify the authoritative payment source and confirm what actually happened. | Report only accepted outcome evidence, kept separate from findings. |
Integration
Built around the feeds you already have
We choose an integration route after reviewing a synthetic sample, a file dictionary, and your expected volume, then validate it with partner testing before real data is sent.
Step 1
Receive
Claims arrive the way you already move them: SFTP, API polling, cloud storage, or file upload.
Step 2
Check
Each claim line runs through the checks configured for its product and plan, before payment.
Step 3
Review
Findings land in an analyst queue with the rule, the expected amount, and the evidence.
Step 4
Return
Decisions flow back to your adjudication system or TPA through the same channel.
Frequently asked questions
- What happens in a historical diagnostic?
- We review an agreed set of already-paid claims and reference material. Scope, data authority, effort, and the deliverable are agreed before work starts. The report states the checks completed and any data gaps; a valid result can include no confirmed errors.
- Does a diagnostic turn into a paid contract automatically?
- No. Implementation is a separate decision with its own scope, milestones, fees, and acceptance criteria. Nothing converts automatically.
- What is shadow mode?
- Trestl reviews claims alongside your current process without changing any payment, so you can compare results before deciding to use findings before payment.
- How do you measure results?
- We report the population and period, the checks completed, data gaps, findings, and your team’s response. A flagged amount, an accepted correction, a confirmed payment outcome, and an attributed financial benefit are always reported as separate measures.
- How long does implementation take?
- It depends on your products, data, and integration route. We agree milestones and acceptance criteria as part of the implementation scope rather than quoting a fixed timeline up front.
Start with a discovery conversation
Bring your products, your questions, and the people who own claims operations. We will leave you with a clear view of whether a next step makes sense.