A TPA operating for self-insured employers, captive programs, or fronting carriers cannot run a single triage rule set across all programs. Each program sponsor has different lines of coverage, different SIU thresholds, and different reporting expectations. Fnolwise is designed for that complexity.
A direct carrier's claims operation is vertically integrated. A TPA's is a service layer between the program sponsor and the claimant — with all of the intake complexity of a carrier, plus the obligation to report back to an external principal whose requirements are not identical across programs.
Fnolwise maintains strict data isolation between program accounts. Triage rules, claim data, and reporting for Program A are never accessible in the context of Program B. The isolation is enforced at the API authentication layer — not just at the application logic level — so your data governance obligations to each program sponsor are structurally supported.
A self-insured retail employer with a workers' comp program has different severity thresholds than a commercial real estate captive with property exposure. Fnolwise allows triage rules — severity thresholds, SIU referral criteria, coverage verification logic — to be configured per program sponsor without affecting other programs in your TPA book. Changes are documented and auditable per sponsor account.
Program sponsors — self-insured employers, captive boards, and fronting carriers — need intake reporting that shows them what is entering their program, not your aggregate TPA intake volume. Fnolwise generates per-program triage summary outputs: intake volume by channel, severity distribution, SIU referral rate, and coverage exception flags. The sponsor sees their program's intake data, not your operational data.
TPAs sometimes run different claims management systems for different sponsor programs — or run one CMS with multiple tenant configurations. Fnolwise integrates with Guidewire, Duck Creek, and Insurity. If your TPA operation has programs on multiple CMS platforms, Fnolwise operates across all three without requiring a single-platform consolidation before you can start.
When a claimant contacts a TPA's intake line — whether that is a dedicated 800 number, a sponsor-branded portal, or an agent submission — the FNOL enters Fnolwise's intake processing layer before reaching your adjuster queue.
Fnolwise identifies which program account the claim belongs to, applies that program's triage configuration, and produces a structured triage record that goes back to your CMS under the correct sponsor program.
Your adjusters receive the file with coverage confirmed, severity scored, and SIU flag evaluated — the same structured handoff a direct carrier adjuster receives, applied to each sponsor program's specific intake requirements.
Each program operates independently with full data isolation. Triage rules, reporting, and CMS routing are configured per account.