Simplify Your SIRCON & NIPR Filing Process
Managing licensure through SIRCON and NIPR can feel like a full-time job. For PBMs and TPAs, every state has its own rules, renewal windows, and documentation quirks—and missing even one step can lead to costly delays or compliance setbacks.
ClearFile was built to take that complexity off your plate. Our purpose-built software streamlines licensure from start to finish—so you can scale with confidence.
Why PBM & TPA Licensure Is So Hard Without Help
Depending on the state, PBMs and TPAs may be required to use SIRCON, NIPR—or both for licensure. But neither system is tailored to PBMs or TPAs, making it difficult to navigate specific requirements, deadlines, and updates without expert support.
- Every state works differently
License types, renewal cycles, forms, and supplemental rules vary across jurisdictions—and tracking it all manually drains time and resources.
- General-purpose portals = specific headaches
SIRCON and NIPR were built for insurers, not for pharmacy or admin entities. That means extra guesswork, extra workarounds, and extra risk.
- Growth multiplies the burden
As you expand into new markets, managing licensure across states becomes exponentially more complex—especially without a system built for scale.
How We Help with PBM & TPA Licensure Compliance
- End-to-End PBM & TPA Licensure Management
ClearFile handles it all—initial submissions, renewals, senior officer ownership and control disclosures, reporting, and correspondence. You stay compliant without the fire drills.
- Clarity Across All 50 States and U.S. Territories
ClearFile SaaS tracks changing state requirements, provides customized regulatory filing instructions, and flags what’s new, due, or missing—so you never miss a beat.
- Scalable Licensing Support for PBM & TPA Growth
Whether you’re a new PBM entering your first state or an established TPA expanding nationally, ClearFile helps you scale your licensing footprint strategically and efficiently.
How We Help with PBM & TPA Licensure Compliance
End-to-End PBM & TPA Licensure Management
Clarity Across All 50 States and U.S. Territories
Scalable Licensing Support for PBM & TPA Growth
Key Features of ClearFile’s PBM & TPA Licensure Platform
ClearFile is tailored to support the realities of pharmacy benefit managers, third-party administrators, and other healthcare-adjacent organizations navigating complex regulatory mandates.
Track license status, submission dates, TPA approvals, and renewal cycles—all in one centralized view.
Securely store RFI documents and correspondence—no more email or SFTP. Data is retained for 10 years in accordance with CMS requirements.
Stop digging through DOI websites—everything you need is built in.
Monitor monthly, quarterly, and annual reporting obligations by state with automated reminders.
Receive real-time alerts—plus access to 275+ PBM- and TPA-specific articles in our dynamic Knowledge Base, covering relevant mandates, policies, and state-by-state requirements.
Licensure is your license to operate.
We make sure it never holds you back. Schedule a demo to see how ClearFile streamlines your compliance operations across SIRCON, NIPR, and beyond.
Built for Growing Teams
For Administrators
ClearFile redefines communication, making the coordination of tasks seamless and effective. Forget about email threads – assign tasks and manage filing work within the platform itself. Effortlessly assign state-specific tasks to dedicated editors, or use a “bulk action approach,” for larger assignment batches. ClearFile streamlines workflow but enhances overall productivity and quality of regulatory filing.
For Filers
ClearFile simplifies the regulatory filing process by offering user-friendly assistance and ready-for-compliance templates, significantly improving your success rate. We provide all the tools necessary for you to complete tasks efficiently, accurately and in line with regulatory standards, reducing filing errors and boosting productivity.
For Team Leaders
ClearFile doesn’t just facilitate the regulatory filing process – it transforms it. Our technology cuts filing time in half, freeing up resources to focus on strategic growth plans. Expand into new markets with a more manageable, efficient system for navigating varying regulations. With ClearFile, you’re not just compliant, you’re competitive, primed for growth and ready to seize new opportunities.
We don’t just follow regulatory trends—we shape them.
Dive into expert insights, real-world success stories, and future-focused guidance built to help you stay compliant, competitive and one step ahead.
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Frequently Asked Questions
If you can’t find the answer to your question here, don’t hesitate to contact us directly. Our team is here to provide personalized assistance and help you with any inquiries you may have about our technology or services.
On average it takes a filer 1,500 hours per year to execute pre and post submission filing work
Clearfile reduces work implementation efforts by 50%, leaving an extra 750 hours per year to allocate to other projects
ClearFile is built for anyone involved in healthcare compliance, regulatory filings, or strategic planning. Whether you’re part of a regional health plan looking to expand or a national carrier keeping pace with evolving requirements, we’re here to support you.
We also work with PBMs, TPAs, consultants, and subcontractors navigating regulatory obligations, as well as professionals in Divisions of Insurance, State-Based Marketplaces (SBEs), Federally Facilitated Marketplaces (FFMs), and National Accounts.
ClearFile is designed to flex with your needs—whether you’re a small organization with limited resources or a large enterprise managing multi-state filings. If staying compliant is part of your role, ClearFile is the partner you can rely on for accuracy, efficiency, and peace of mind.
ClearFile takes the stress out of keeping up with constantly changing legal requirements. From clear deadlines to simplified filing directions, everything you need for success is available within the platform. ClearFile also provides measurable analytics, enabling our clients to track their progress and make data-driven decisions. This comprehensive approach ensures that our clients achieve filing success, keeping them compliant, informed and ready for any regulatory challenge that comes their way.
Our software integrates directly with the official system where state rules are issued throughout the year, so you never miss an update. We also keep tabs on the major federal rules to ensure our partners’ compliance. If you’re overwhelmed by the sheer volume of legislation to review, we’ve got you covered. Our process can condense around 100 pages of legislation from various sources into an average of just a single page. All this crucial information, including important due dates, instructions, and supporting documents, is stored in our software platform. This serves as our main distribution channel, making it easy for every user to access the resources they need to stay compliant and informed.
Start by exploring our demo and meeting our team to understand how we’re elevating regulatory filing. Our comprehensive resource library and user guide, along with a dedicated Client Success Manager, make onboarding smooth. The setup is quick and tailored to your needs, ensuring your filing success story starts off strong.
ClearFile offers stellar customer service with guaranteed response times for support inquiries through our dedicated Help Desk. From 8am – 8pm EST, our experts are ready to provide timely assistance. Our implementation and ongoing support offerings range from a technology-focused SaaS solution to a flexible hybrid model and even a full-scale outsourcing service. We’re committed to flexibility, ensuring our involvement aligns with your needs.
At ClearFile, we prioritize data protection, and our SOC 2 Type 2 Report affirms our commitment to data security. Additionally, our data is stored securely across multiple ISO/IEC 27001:2013 and NIST SP 800-53 certified locations. We use advanced encryption methods, adhere to OWASP Web Security Testing Standards, and support SSO and MFA for added security layers. And we meet all CMS and State DOI healthcare regulatory and compliance certifications.
Standardized reviews of an Issuers Good Standing are a key part of vetting new clients to ensure they are an active Life and Health, commercial product carrier authorized by states they participate in, and by CMS to transact fully insured health insurance to members and persons of a given geography. This includes robust evaluation of quality ratings, any conservator/receivership, and health and wellness of the Qualified Health Plan product to ensure there are no risks to be mitigated up front.
ClearFile proactively seeks out, addresses, and implements improved processes throughout each year. We perform robust lessons learned exercises during Q3 and Q4 of each year post-certification with each individual stakeholder business area (and collectively) to align on what went well, opportunities for improvement, and execution to the following year’s implementation and project plans. This is a critical exercise that we have proven to be incredibly successful with clients. From reducing change controls, objections, filing re-openings, to also modifying the product to be more competitive (e.g. implementing new VBID programs, QHP marketing AEP campaigns, evaluating new metrics and analytics, and more).
We’re active members of many health plan associations and we attend standing weekly CMS QHP Webinars, as a part of the REGTAP listening series. We also attend industry-wide calls to collect, disseminate, and distribute real-time updates to our client and carrier partners. Data is benchmarked year-over-year to assess changes and are cascaded down to stakeholders. This is inclusive, but not limited to real-time, door-to-door delivery of all state filing guidance and timeline updates via the SERFF system as binders are configured each year using our proprietary ClearFile Software integration with the NAIC’s open APIs attached to the SERFF system.
