Notes from the line.
Straight answers for the people who run TPA and health plan call operations: what provider calls cost, how to automate them, and how to keep PHI safe while you do.
What does a provider call cost a TPA?
In-house provider calls typically cost a TPA $6 to $12 each, offshore BPOs $2 to $5, and EHVAhealth starts at 50 cents per call. Here is how the math works.
How TPAs cut provider call volume without hiring
TPAs are moving eligibility, benefits, and claims status calls to voice AI. Acuity Group automated 81% of in-scope calls; CareFactor reached 90%.
Voice AI vs. an offshore BPO vs. more staff for provider calls
Three ways a TPA can handle eligibility, benefits, and claims status calls: in-house staff, an offshore BPO, or voice AI. Cost, hours, and quality compared.
Does voice AI work with MediClaims, Five9, and Salesforce?
EHVAhealth is WLT Software's preferred voice AI partner for MediClaims, and runs inside Five9 and Salesforce at WellNet Healthcare. How the integration works.
Is voice AI HIPAA compliant? 9 questions to ask before PHI is on the phone
Voice AI can handle PHI on provider calls in a HIPAA-compliant way with the right controls. Nine questions to ask a vendor, and what good answers sound like.
Containment is the wrong metric for provider calls
A call line that never escalates is not a line that resolves. Why TPAs should measure resolution, not containment, when automating provider calls.
TPAs already running on EHVAhealth
Acuity Group: 81% automated
Claims, eligibility, and benefits calls answered end to end for a TPA covering 16,471 lives.
Read the case studyCareFactor: 90% autonomy
Benefits and claims calls answered from plan documents and EOBs, 24/7, for 30,000 lives.
Read the case studyWLT Software partnership
WLT endorses EHVAhealth as its preferred voice AI partner for MediClaims customers.
Read the announcementHear it answer a provider call
Real recorded calls, or a live call to your own phone. Pricing starts at 50¢ per call.