How It Works

We Empower the Self-Insured to Take Control of Healthcare Costs

A woman using a computer

A significant advantage of self-insured plans is the increased ability to manage healthcare costs. The real-time power of the payment networks – available to all health plans – helps prevent, detect and deter fraud and benefit identity thefts in your health plan. These hidden expenses cost health plans and member between 3% and 20% of costs each year

We address the conditions that enable fraud and identity theft.

Castlestone also uses existing payment networks to manage customer incentives for healthcare decisions.

Image of a verification card

Step 1 - Verify Transactions Using Identification Cards

To get started, Castlestone Advisors, LLC issues and manages an identification card. These cards are distributed to all members of the health insurance plan. They can be read at any standard credit card terminal and deliver real-time information to our customers. Castlestone educates staff within the health plan on how to use the cards.

The cards have the following features:

  • No protected health information
  • No financial risk
  • Scanned at each visit to healthcare provider using the same terminal they use for credit card transactions.
Swiping a card at a medical facility
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Step 2 - Gather and Process Information at the Point of Care

When a beneficiary visits a provider, the front office staff swipes the identification card in the same terminal used for debit or credit card transactions. A pre-selected code is also entered. 

Each card swipe carries data we use in anti-fraud activities:

  • Card Identification 
  • Owner and location of the swipe terminal
  • Merchant code of the terminal
  • Transaction code entered
  • Time Stamp

Our business rules engine then processes this information in real time to determine fraud-related data, including: 

  • Is this card terminal in our database of providers?
  • Has the card been lost or stolen? Are there any restrictions?
  • Has the card been swiped at another location?
  • Does the member already have a prescription for a Class II drug?
  • Who is the payer of record for this beneficiary? 

Depending upon client needs, other real-time analyses can be created.


Report mismatches on the portal dashboard as soon as they are identified and long before the claim is ever paid.

Castlestone portal mockup
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Step 3 - Automatically Verify Claims with our Services

When a claim is received from the provider for a clinic visit, prescription, or medical device transaction, we match it to the data received from the card network. Because of our real-time card checks, some claims can be rejected outright. Others can be suspended pending further review. 

Castlestone provides a portal to give access to real-time and historical data. Reports and exceptions can be delivered with a simple point-and-click interface.  

  • The portal is available for use by all users authorized by the customer (doctors, pharmacists, customers, and members), with access controllable by the customer
  • Real-time analysis and alerts are standard
  • Users generate custom reports depending upon their level of security
  • Administrative functions, such as reporting and replacing lost or stolen ID cards 

Protect Your Identity

Over 150 million Americans have had their medical identities stolen in the last 5 years. Many self-insured companies carry risk of fraud, including rising costs. These identities are worth between $250-$1,000 on the dark web. Why? Because no health insurance claims system can tell whether a stolen identity is behind the claim.

Castlestone can.