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Welcome to Turquoise TEP

The Turquoise Transaction Efficiency Platform (TEP) is a cloud-native system designed to eliminate waste and complexity from healthcare claims processing. Rather than submitting claims after services are rendered and then waiting months for payment, TEP enables guaranteed, personalized, bundled pricing upfront—transforming healthcare finance from a reactive adjudication system into a deterministic orchestration engine.

This documentation covers the hosted Turquoise TEP offering, which integrates with payers, providers, and plan sponsors via APIs and a fiduciary ledger architecture. For open-source components and lower-level resources, visit open.turquoise.health.

The Core Value Proposition​

Healthcare today operates on a claim-submit-adjudicate-appeal cycle that introduces unpredictability, administrative burden, and unnecessary cost. TEP replaces this with three interconnected capabilities:

Guaranteed Prices. Direct Contracts between payers and providers define bundled rates—either per episode (total knee replacement), per encounter (colonoscopy visit), or per item/service (CPT code). These rates are contractually binding and enforced in real time. Patients receive a Good Faith Estimate (GFE) before service and an Advanced Explanation of Benefits (AEOB) after, both with a Maximum Cost Share that acts as a price lock.

Packaged Billing. Rather than processing dozens of separate claims from multiple providers (surgeon, facility, anesthesia, pathology), TEP groups these into a single Standard Service Package (SSP). One encounter; one price; multiple provider shares automatically calculated and disbursed via Stripe Connect.

Waste-Free Real-Time Transactions. Payment flows from payer to provider within seconds of claim submission. There are no outstanding receivables, no manual adjudication, no payment appeals—only a fiduciary ledger that connects clinical intent, contractual reality, and financial settlement. Every dollar traces back to a voucher, an encounter, and a patient.

Who Is This For?​

TEP serves three distinct audiences, each with specific workflows and integration patterns.

Healthcare Providers​

Providers (hospital systems, outpatient facilities, independent practitioners) use TEP to streamline revenue cycle operations. Your workflow: receive an Estimate Request from a payer, generate and send a Good Faith Estimate, convene with the payer on final pricing, receive an Advanced Explanation of Benefits as a price guarantee, deliver the service, submit a Claim, and immediately receive a ClaimResponse with payment instructions. Your settlement is automatic and deterministic—no surprises, no appeals, no manual reconciliation. You can group multiple CPT codes into bundled pricing units (e.g., a "Double Header" combining two procedures, multiple provider roles, and facility charges into a single negotiated rate). Payment arrives via Stripe Connect with full audit trails and no PHI stored in payment systems.

Trading Partners (TPAs, Payers, Plan Administrators)​

Trading Partners—including Third-Party Administrators (TPAs), health plans, and plan sponsors—use TEP to enforce contractual pricing, validate claims against Direct Contracts, and approve payment flows. Your workflow: define or retrieve Direct Contracts, check contract availability for incoming Estimate Requests, review pricing logic and grouping rules, send Convened Estimates and AEOBs, validate Claims against Contracts, confirm pricing and coverage, approve Fund Flows, and settle payment through Stripe. You maintain fiduciary oversight of guaranteed savings—every price lock is auditable, every payment is traced, and exceptions (emergency services, out-of-scope care) are logged and reconciled via "True-Up" transactions.

Plan Sponsors and Employers​

Plan Sponsors and self-insured employers use TEP for visibility and fiduciary assurance. You see real-time pricing for bundled episodes and encounters, you can validate that providers are respecting negotiated rates, and you have full audit trails for compliance and cost management. Unlike traditional claims processing, where you don't know what you'll pay until months after service, TEP gives you certainty upfront and a ledger-driven reconciliation at the end.

How It Works​

The TEP workflow can be summarized in six stages:

  1. Estimate & Price Lock. A patient schedules a service. The provider (or payer) requests a Good Faith Estimate. TEP looks up the Direct Contract, validates bundling rules, and returns pricing for all included services. The patient receives the AEOB with a Maximum Cost Share—a financial ceiling that never changes, even if the actual claim is higher.

  2. Service Delivery. The patient arrives, the service is rendered, and clinical documentation is captured. Multiple providers (surgeon, facility, anesthesia, pathologist) each contribute to the episode.

  3. Claims Grouping & Submission. Claims are grouped into a single Standard Service Package (SSP) by encounter and CPT code. Professional claims (surgeon, anesthesiologist) and institutional claims (facility) are submitted simultaneously. TEP validates each against the Direct Contract.

  4. Pricing & Payment Approval. TEP prices each claim using the bundled rate from the contract, calculates provider shares, and generates a ClaimResponse with payment instructions. The payer (via trading partner approval) authorizes the fund flow.

  5. Stripe Settlement. Payment is split and transferred to provider accounts via Stripe Connect. Each transfer is tagged with an opaque trace_id (no patient data in Stripe) and linked back to the original encounter.

  6. True-Up & Reconciliation. If the actual cost is lower than the AEOB, the patient is refunded automatically. If the actual cost is higher (e.g., emergent services), the delta is a "Fiduciary Adjustment" settled between provider and plan.

Here is a simplified view of the encounter lifecycle:

Next Steps​

Begin with Encounter Lifecycle to understand the full claims and pricing workflow. Then explore Bundled Pricing & SSPs to learn how rates are defined and packaged. For implementation details, see Fast FHIR R4 Mapping and Fiduciary Ledger.

To get started quickly, see the Quickstart Guide. For TPA integration details, see the TPA Integration Guide. For API details, jump to the Blind Contract Lookup endpoint.