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Case Study

Case Study of Third Party Administration (TPA): 81% of Provider Calls Processed Without Human Intervention

EHVA autonomously handles claims, eligibility, and benefits inquiries for 16,471 covered lives, 24/7.

Last updated: January 7, 2026

EHVA was deployed to autonomously handle inbound provider calls for a Third Party Administrator supporting 16,471 covered lives for one of multiple groups with the goal of alleviating call center load and providing services 24/7. The system was designed to manage eligibility, benefits, and claims inquiries end-to-end, while intentionally excluding member services and prior authorizations. The deployment achieved 81% autonomy on in-scope calls in its first formal production assessment, with clear paths to further optimization.

81%

Reduction in calls.

16,471

Covered lives

13,500

Monthly calls processed

24/7

Call handling

The Challenge

Provider call volume placed a consistent operational burden on live staff, particularly for repetitive, transactional requests such as eligibility verification and benefits inquiries. This prevented the client from scaling operations and enrolling additional clientele not just from cost, but because of the physical limitations of the existing call center (square footage, staffing, IT, management, etc.). The client needed a solution that could:

  • Handle provider calls accurately and autonomously using information updated daily
  • Maintain strict scope boundaries
  • Preserve compliance with healthcare data handling requirements
  • Escalate only when necessary

Results

A formal production assessment showed:

  • 81% of in-scope calls handled autonomously
  • 19% escalation rate on in-scope calls
  • Includes after-hours calls in the evaluated sample
  • EHVA operating full-time in production

When accounting for scope classification, EHVA autonomously resolved approximately 71% of all inbound calls with the possibility of exceeding 80% of total gross calls if it’s decided to move member calls into scope.

Listen to Claims, Eligibility, and Benefits calls

Listen to Ash

Claims Status Inquiry

Provides real-time claim status updates without transferring to a representative.

Listen to Aiden

Provider Eligibility Verification

Verifies member eligibility and benefits instantly by accessing the TPA database in real-time.

Listen to Ash

Eligibility With Accumulated Benefits

Answers questions about coverage, deductibles, and copays by pulling member-specific data.

Listen to Aiden

Claim Paid Inquiry

Provides detailed information on claim payments, including amounts and dates, without human intervention.

Compliance & Data Handling

EHVA was deployed with healthcare compliance requirements in mind, including:

  • HIPAA-aligned handling of PHI
  • Controlled access to eligibility, benefits, and claims data
  • Intentional scope restrictions to reduce risk exposure
  • Full call logging and auditability
  • SOC2 datacenter compliance

No member services or prior authorization workflows were included in scope by design.

Conclusion

This deployment demonstrates EHVA’s ability to operate reliably within a regulated Third Party Administration environment, handling high-volume provider calls with minimal human intervention while maintaining operational control and compliance.

“Working with EHVA has been transformative — innovative solutions and visionary thinking have carried us to new levels of success.”

— Tyler Reeves, Chief Operating Officer, Acuity Group

See also

What makes EHVA different? 5-Day deployment time How much does EHVA cost?
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How does EHVA sound?

Want to hear what EHVA actually sounds like? Listen to a few real recordings below and experience the difference for yourself.

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Listen to Mira

Hospitality - In-Room Dining

Takes orders, integrates with your POS, communicates modifications, and upsells every time.

Listen to Rosa

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Listen to Ash

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Processes guest requests and routes them to the right department in your PMS, no front desk tie-up.

Listen to Aiden

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Collects policy information, confirms an eligible partner match exists, and schedules quick callback.

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Screens callers, passes enriched lead data, and transfers within your buyer's billing window.

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Collects home and auto details and books a qualified appointment.

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Marriott Reservation - CSR

Handles thousands of simultaneous inbound calls and takes action based on each conversation.

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Provider Eligibility Verification

Verifies member eligibility and benefits instantly by accessing the TPA database in real time.

Listen to Aiden

Claim Paid Inquiry

Provides claim payment details (amounts, dates, and status) without human intervention.

Listen to Danielle

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Handles prospective guest questions, guides them through booking, and texts a secure payment link.

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Debt Relief - Qualification

Ensures the caller meets your eligibility requirements before hand-off.

Listen to Julia

Lululemon - CSR

Processes returns, checks inventory, provides directions, and handles other eCommerce inquiries.

Listen to Ash

Claims Status Inquiry

Provides real-time claim status updates without transferring to a rep.

Listen to Aiden

Waste & Recycling - Schedule Inquiry

Answers customer questions and provides schedule details from your company's knowledge base.

Listen to Ash

Eligibility With Accumulated Benefits

Answers questions about coverage, deductibles, and copays by pulling member-specific data.

Listen to Ash

Argonaut Hotel - Property Information

Answers FAQs instantly by pulling details from your property knowledge base.

Listen to Adam

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Listen to Aiden

Burger Bar - Placing an Order

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Listen to Alana

Waste & Recycling - Payment Assistance

Confirms the caller's account and texts a secure payment link.

Listen to Becky

Insurance - Intake Interview

Qualifies leads so your agents can focus on closing.

Listen to Erin

Acuity - Eligibility Check

Verify medical eligibility, retrieve patient data instantly, and transfer complex cases to live reps.

Listen to Rosa

Hospitality - Outlet Info & Reservations

Answers property and outlet questions and handles reservation actions in real time.

Listen to Aiden

Argonaut Hotel - Late Checkout

Grants complimentary late checkout, if property policies and current occupancy allow, and escalates when needed.

Listen to Aiden

Argonaut Hotel - Valet Request

Processes guest requests and routes them directly to your valet team.

Listen to Janice

Utility Outage - CSR

Troubleshoots outage issues and takes real-time action to resolve them.

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EHVA is a conversational phone A.I. built by telecom and telesales professionals—not venture capitalists. We don’t use consumer tools like GPT or Twilio, and we never lock clients into long-term contracts or teaser rates. Most clients go live in 5 days, and all qualified businesses start free.

EHVA integrates with your systems, handles real-time calls, billing, sales, intake, and more—24/7. We’re secure, compliant, and proven. Want to hear it? Listen to real calls. Want to try it? Fill out the form and we’ll show you what EHVA can do.

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