PayForward provides a unified fintech platform that consolidates supplemental health‑plan benefits onto a single Mastercard‑branded prepaid Flex Card, enabling real‑time authorization, multi‑purse configuration, and instant rule changes. The solution includes AI‑driven utilization analytics, automated CMS compliance updates, and enterprise‑grade security, helping Medicare, Medicaid, ACA exchanges, and commercial insurers streamline administration and improve Star rating performance.
Funding
$5M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
Health plans often manage supplemental benefits through multiple cards and third‑party processors, leading to fragmented member experiences, high administrative overhead, and slow adaptation to CMS regulatory changes. This complexity hampers real‑time tracking, fraud prevention, and data‑driven program optimization. Consequently, plans struggle to demonstrate ROI and improve Star rating performance.
Solution
PayForward delivers a unified benefits‑payment platform that consolidates diverse supplemental programs onto a single, Mastercard‑branded prepaid Flex Card. The platform’s proprietary fintech engine, built on peer‑to‑peer payment infrastructure, enables real‑time authorization, multi‑purse configuration, and instant rule changes without intermediary delays. Integrated AI analytics surface care‑gap opportunities and track utilization to support Star rating improvement. A built‑in compliance engine automatically incorporates CMS updates, while enterprise‑grade security (HITRUST and PCI‑Level 1) safeguards member data. The solution includes white‑glove implementation and ongoing support, ensuring plans retain full program control and can rapidly iterate benefit designs.
Target Audience
The platform is targeted at health plans—including Medicare, Medicaid, ACA exchanges, commercial insurers, and federal employee programs—that need a scalable, compliant solution for administering supplemental benefits and improving member engagement.
Features
- Single Flex Card supporting multiple benefit “purses” (OTC, vision, utilities, fitness, rewards) with configurable spend limits, expiration, and rollover rules
- Proprietary fintech stack with direct banking relationship for instant fund allocation and real‑time transaction authorization
- AI‑driven care‑gap identification and utilization analytics that feed into Star rating dashboards
- Dynamic compliance engine that auto‑updates program logic to reflect CMS policy changes
- Enterprise‑grade security framework (HITRUST, PCI‑Level 1) with continuous fraud monitoring and rule‑based spend controls
- Full API suite for EHR, claims, and third‑party system integration, supporting FHIR‑compatible data exchange
- White‑glove onboarding, custom benefit design, and 24/7 member‑portal access with real‑time balance and transaction history
- Advanced reporting console offering customizable views by market, employer group, program, and time period