MediClaims
WLT Software Enterprises develops MediClaims, a claims adjudication and benefits administration platform used by third-party administrators and health plans. Under the WLT partnership, EHVAhealth answers provider and member calls using the eligibility, benefits, and claims information MediClaims customers already maintain, so callers get accurate answers without a staff member looking anything up. Read the announcement.
Five9 and Salesforce
At WellNet Healthcare, EHVAhealth handles inbound provider calls across medical, dental, and vision plans while running alongside the existing Five9 contact center and Salesforce CRM. When a provider needs a person, the call is handed to a WellNet agent with the context of the conversation, and call activity is logged back to Salesforce, so the TPA keeps a complete record of every provider interaction. Read the announcement.
Other platforms
The same approach applies to other admin and adjudication platforms. EHVAhealth connects through the platform's API where one exists. Where there is no API, it uses a secure data feed, a scheduled extract, or a supported integration partner. That path is settled in discovery, not on go-live day.
What does not change
- Your phone numbers. The agent can sit behind your existing numbers and IVR, take overflow only, or run a dedicated line.
- Your systems of record. Data stays in your platform; the agent reads what it needs to answer the call.
- Your team's tools. Escalations arrive in the queue your agents already work.
What is needed to get started
Three things: system access (API credentials for your admin or adjudication platform, and a test environment if you have one), your call rules (how callers are authenticated, what can be disclosed to whom, and when a call must go to a person), and one owner who can approve scripts and escalation rules. Typical time from kickoff to live calls is about five days for a single call type on a platform with a modern API.