Provider claims status, answered on the first call.
Every provider who calls to check a claim gets an accurate, real-time answer from EHVAhealth: status, payment, and denial detail, without waiting on hold or pulling your adjusters off their work.
The calls that never stop coming
Claim status is the single most repeated question a benefits operation fields. Providers call to ask the same things every day, and each call pulls a trained person away from work that actually needs judgment. EHVAhealth takes the whole line.
High volume, low variety
The same status, payment, and denial questions, thousands of times a month. Perfect for a service built to resolve them cleanly.
Your best people, tied up
Adjusters and CSRs spend their day reading claim records aloud instead of handling the calls that need a human.
Provider relationships strained
Long holds and callbacks are the top complaint providers have about payers. First-call answers fix it.
Authenticate, look up, answer, log
Every call follows the same disciplined path, connected live to your adjudication system so the answer is always current.
Authenticate the caller
Verify the provider and the specific member and claim securely before any detail is shared.
Pull the claim in real time
Query your admin or adjudication platform live, so status and payment reflect the current record.
Give the full picture
Status, paid amount, check or EFT date, and denial or adjustment reason, in plain language.
Log and route exceptions
Document the call, and hand anything that needs a person to your team with full context attached.
Everything a claims status line needs
Real-time status and payment
Current claim status, paid amounts, and check or EFT dates on the call.
Denial reasons, explained
CARC and RARC codes translated into language a provider can act on.
Medical, dental, and vision
One line across all your plan types, not a separate queue for each.
Timely-filing and appeals
Filing windows and appeal status surfaced, with routing when a case needs review.
Every call QA-scored
Quality reviewed on all calls, with the scores reported back to you.
Dashboards and reporting
Volume, resolution, and containment you can see, not guess at.
Failover to your team
If anything interrupts service, calls route to your standard handling. No caller is stranded.
Connects to your systems
Reads live from your adjudication or admin platform through its API.
PHI kept in bounds
Protected data stays inside an access-controlled, audited environment.
Hear what a claims status call actually sounds like
Real handling, on your plan types, before you commit to anything.
Fewer holds, cleaner calls, lower cost
Call resolution
Answer speed
Onboarding
Quality coverage
Claim data stays protected
Every claims status call touches PHI, so the whole workflow runs inside a controlled, audited environment. We give your compliance team the documentation they need before the first call is answered.
Claims status, answered
Does this connect to our adjudication system?
Yes. EHVAhealth reads live from your admin or adjudication platform through its API, so callers hear the current status, not a stale copy. If your system lacks an API, our team finds an alternative path during onboarding.
Can it explain denials and appeal status?
It surfaces denial and adjustment reasons in plain language, including the underlying CARC and RARC codes, and reports appeal and timely-filing status. Cases that require review are routed to your team with full context.
Does it cover medical, dental, and vision?
Yes, across all your plan types on a single line, rather than forcing providers into separate queues.
How is protected health information handled?
The workflow is HIPAA compliant and runs under a signed BAA. Data stays in an access-controlled, audited environment, and our controls are mapped to the HITRUST CSF. Your compliance team can request the full security package before go-live.
What happens when a call needs a person?
Escalation rules are set with you. When a caller asks for a human or a case falls outside scope, the call hands off cleanly to the right person or queue, with the context preserved.
Handle the rest of the line too
Eligibility & benefits
Coverage, benefits, and accumulator balances confirmed on the call.
View solutionHealth risk assessments
Complete more HRAs by phone, without standing up a call center.
View solutionProvider search
Members find in-network care on the first call, with a texted shortlist.
View solutionTake claims status calls off your team's plate
No pitch. We will show you real claims handling built for your plan and your systems.