Compliance Foundation
SOA capture and storage, TCPA consent with revocation tracking, DNC scrub alerts, 6-year minimum recording retention, and an audit log on every write.
Built for Medicare call centersCompliance-first lead attribution for
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Compliance-first lead attribution for
Medicare call centers that can't afford to guess.
Trace every lead from first touch through contact, quote, enrollment, commission, and renewal — and know which sources produce policies that stay on the books.
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30-day money-back guarantee · 50% off setup for the first 5 founding agencies · Live from day one
claimflow/dashboard
ClaimFlowDashboardLeadsAttributionComplianceCallsRevenue
Lead-to-renewal funnel
Lead
Contact
Quote
Enrollment
Commission
Renewal
Compliance checks
SOA capturedTPMO disclaimer detectedDNC scrubbedConsent expiring soon
Audit trail
Record complete
- LEAD
Inbound call — live transfer
- TCPA written consent on file
- DNC scrubbed before dial
- CONTACT
Agent connected — licensed in state
- SOA captured before plan discussion
- TPMO disclaimer detected
- QUOTE
Plan quoted, carrier appointed
- ENROLLMENT
Policy bound
- COMMISSION
Carrier statement matched
- RENEWAL
Year-2 renewal traced to originating source
- 6yr
- min call retention required by CMS
- 12
- all-party consent states
- 5
- attribution models
- 12–24mo
- history imported on day 1
When the complaint comes
What happens when a complaint lands.
No one from CMS will ever audit your shop — CMS regulates carriers, not agencies. The enforcement you'll actually meet is your carrier's broker-oversight unit. And it moves on a single complaint.
- 01
The call you never hear about.
A beneficiary — or their adult kid — dials 1-800-MEDICARE. The complaint lands in CMS's tracking system with your agent's name and NPN attached.1
- 02
The carrier investigates. Every one.
Aetna's producer guidelines, in writing: “a full investigation conducted in response to every complaint received.”2
- 03
They ask for the artifacts.
The call recording. The Scope of Appointment. Proof of consent. The lead source. Federal rules required that call to be recorded in its entirety.3
- 04
No recording? You lose by default.
Corrective action, suspension, or contract termination — at the carrier's discretion.4
- 05
The termination follows you.
For-cause terminations are reported to CMS and your state, with reasons. Every other carrier's appointment application asks about it.5
- 06
The book follows the appointments.
Lose those, and the renewal income you spent years building goes with them.
Step 3 is where it's decided
ClaimFlow's answer to step 3 takes about ninety seconds.
Every call, every SOA, every consent record — tied to the enrollment, retained on schedule, ready to produce. The audit that ends other shops becomes an email you answer before lunch.
- #1
- Insurance draws more TCPA lawsuits than any other industry — about 28% of federal filings Source: 2025 litigation-tracker data
- $990K
- What one small Florida agency paid to settle claims over calls its lead vendor made Source: Top Class Actions
- 73,000+
- Complaints in six months alleging seniors were switched into plans without consent Source: Health Affairs
- 6 yrs
- Minimum retention for Medicare marketing-call records under the CY2027 CMS rule Source: CY2027 Final Rule
Sources: 1. CMS Complaint Tracking Module SOP (Jan 2025) · 2. Aetna Individual Medicare producer certification guidelines · 3. 42 CFR § 422.2274(g) — call recording requirement · 4. Ritter Insurance Marketing — call recording FAQ · 5. 42 CFR § 422.2274(c)(2)–(3) — termination reporting
The compliance stakes
Audits are existential.
Medicare call centers operate under CMS, TCPA, and state DOI regulations that most agencies handle with spreadsheets and hope. Get audited without the records, and the cost isn't a fine — it's lost carrier appointments and a lost book of business.
SOA
Scope of Appointment captured before any plan-specific discussion
Missing SOA = lost commission + audit failure
TPMO
TPMO disclaimer stated on every recorded call
Missing disclaimer = CMS violation
RET-6
6-year minimum call recording retention for Medicare sales calls (CY2027)
Required by CMS — no recording, no defense
TCPA
Prior express written consent per recipient, with revocation tracking
Consent gaps invite litigation
DNC
Do-Not-Call scrubbing before any outbound dial
Every unscrubbed dial is exposure
2-PARTY
All-party recording consent required in 12 states
State-by-state rules, one recording policy won't do
DOI
Agents sell only in states where they're licensed and appointed
Unlicensed sales put carrier appointments at risk
The attribution blind spot
$10K–$100K a month on leads. Tracked in spreadsheets.
Agencies buy from 15+ lead sources and still can't answer the questions that decide where next month's budget goes. No existing tool maps the full lead-to-renewal cycle for insurance.
- Q1
Which lead source produces policies that actually renew instead of lapse?
- Q2
What's the true cost per acquisition — including agent time?
- Q3
Which agents close best on which lead sources?
- Q4
If you reallocate $5K from Google Ads to live transfers, what happens to revenue?
The solution
Compliance is the wedge.
Attribution is the retention.
ClaimFlow solves compliance first, then layers revenue attribution on top. No existing tool does both.
Identity Resolution
One person, one record — matched across web forms, calls, transfers, and vendor CSVs. Historical backfill imports 12–24 months of leads and commission statements on day 1.
Deterministic Attribution
Every lead, call, quote, enrollment, commission, and renewal connected in a directed graph, with Markov chain removal effect. First-touch, last-touch, linear, time-decay, and position-based models side by side.
Revenue Cycle Dashboard
The full funnel in one place: cost per acquisition including agent time, LTV by channel, persistency, and chargebacks.
AI Insights
Ask questions in plain English. Anomaly detection flags close-rate drops and cost spikes. Every AI claim is tagged, so you know what's proven and what's inference.
The small-data honesty layer
Competitors show fake precision.
ClaimFlow shows honest uncertainty.
Attribution models trained on thin data produce confident-looking nonsense. ClaimFlow tells you when the data is thin — right in the interface.
± CI
Confidence intervals
Markov attribution ships with confidence intervals — not point estimates dressed up as certainty.
n < 30
Low-confidence badges
Under 30 conversions, results wear a visible “low confidence” badge. No silent guessing.
n < 10
Disclosed fallback
Under 10 conversions, the model steps aside: automatic fallback to last-touch, disclosed in the UI.
The landscape
The gap between marketing tools and insurance tools.
Marketing tools don't understand insurance compliance. Insurance tools don't understand attribution. ClaimFlow bridges that gap.
| Tool | Insurance-specific | Compliance | Attribution | Price |
|---|---|---|---|---|
| ClaimFlow | Yes | Yes — CMS, TCPA, SOA | Yes — deterministic + hyperbolic similarity insights | $399–$6,999/mo |
| Ricochet360 | Yes | Partial | Basic | $150–$500/mo |
| Convoso | Yes | Partial | Basic | $100–$300/seat |
| AgencyZoom | Yes | Minimal | No | $99–$299/mo |
| Invoca | No | No | Basic (call-level) | $500–$5,000/mo |
Already running Convoso or Ringba? Good — keep them. ClaimFlow connects to your dialer instead of competing with it — the dialer makes the calls; ClaimFlow proves what they were worth and that they were compliant. See integrations.
Founding cohort · first 5 agencies
Five agencies get the founder's deal.
50% off setup, your monthly rate locked for as long as you stay, and a 30-day money-back guarantee on the monthly fee. Live from day one — no pilot purgatory.