Monument
Health plan administration software for managed care, Medicare, Medicaid, and commercial markets
Overview
Monument Systems is a health plan administration software provider serving managed care organizations, health plans, TPAs, Medicare Advantage, Medicaid, delegated IPAs, ACOs, and PACE plans. The company offers configurable software modules covering claims processing, prior authorization, enrollment, fax and communication automation, and appeals and grievances management.
The platform, branded Monument Xpress, delivers core claims administration alongside AI-driven automation across intake, prior authorization, enrollment, and appeals workflows. Modules are available individually or as a suite, integrating via REST APIs and direct CMS connectivity. The company also offers Business Process Outsourcing (BPO) and Business Processing as a Service (BPaaS) for healthcare operations. Notable implementation timelines include Xpress Communication deploying in 30 days and the full claims system in 6 months.
Monument Systems was co-founded by Ken Stockman (CEO) and Dominic Wallen with offices in Huntington Beach, CA; Tucson, AZ; and Pune, India. The flagship claims system has been in market since 1999. The company is bootstrapped with no disclosed external funding. Customers include One Senior Care and the County of Riverside.
Products & Services
Monument Xpress Claims
Core claims processing system for managed care, delegated IPA, TPA, ACO, Medicare Advantage, and Medicaid markets. Implements in approximately 6 months with embedded workflow technology.
Key Features
- Full claims adjudication and administration
- Embedded configurable workflow
- Support for Medicare Advantage and Medicaid lines
- Implemented in roughly half the time and cost of traditional systems
Target Users: Health plans, TPAs, delegated IPAs, ACOs
Xpress Auth
AI-driven prior authorization automation module. Features a proprietary AI model for triage and case routing, designed to comply with the CMS 0057 Final Rule.
Key Features
- Proprietary AI model with 92%+ triage accuracy
- 90%+ improvement in prior authorization turnaround time
- CMS 0057 Final Rule compliance
- Deployment in 2-4 months
Target Users: Health plans, managed care organizations
Xpress Communication
Secure fax and communication automation module. Automates inbound fax handling and integrates with plan workflows. Deploys in as little as 30 days.
Key Features
- Inbound fax automation (7-day deployment)
- Fax UI tracker live feed (10 days)
- Notification manager and member status portal
- Communication API integration
Target Users: Health plans, TPAs
Xpress Enroll
AI-driven enrollment module for Medicare, Medicaid, and commercial lines of business. Connects directly with CMS for eligibility and enrollment management. Used by PACE plans for Medicaid enrollment.
Key Features
- Direct CMS connectivity for eligibility and enrollment
- Supports PACE, Medicare, Medicaid, and commercial enrollment
- Handles complex regulatory requirements for PACE plans
Target Users: Health plans, PACE plans
Xpress Appeals and Grievances
AI-driven appeals and grievances platform for case resolution with regulatory compliance. Launched April 2026.
Key Features
- AI agents for intake, clinical summaries, case processing, workflow, and chatbot
- Compliance with complex regulatory deadlines
- Integrated automation and intelligence
Target Users: Health plans, managed care organizations
Xpress Clinical Assistant
Standalone AI web and mobile tool for clinical decision support in prior authorization and clinical appeals.
Key Features
- Human-approved clinical workflow
- Available on web and mobile
- Supports prior auth and clinical appeals decisions
Target Users: Clinical staff at health plans
BPO and BPaaS Services
Business Process Outsourcing and Business Processing as a Service for healthcare payers. Provides staffing and process operations alongside software licensing.
Key Features
- Custom healthcare AI work
- Business process operations for health plans
- Delivered from India operations center
Target Users: Health plans, TPAs
At a Glance
- Founded
- 1999
- Headquarters
- Huntington Beach, California
- Employees
- 11-50
- Funding
- Bootstrapped
Category & Focus
- Category
- Core Administration
- Subcategories
- Claims Administration Prior Authorization Enrollment Appeals & Grievances
- Insurance Verticals
- Health
- Target Customers
- Carriers, TPAs
Customers
- One Senior Care (PACE plan) -- Xpress Enroll for Medicaid enrollment
- County of Riverside -- Monument Xpress claims system
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Last updated: 2026-06-03