AI Helps TPAs Reimagine Efficiency, Security, and Customer Experience — And Prepare for the Future
TPAs face a myriad of day-to-day challenges. Data manipulation, enrollment processing, claims handling, uploads, and communications all require countless hours of work. And when multiplied by many clients, these tasks can quickly become unwieldy. That’s where AI virtual agents come into play.
Using AI, TPAs are able to streamline processes, freeing up the workforce to do other revenue-generating tasks. From automating claims reviews to handling enrollment data processing and more, AI has become a powerful tool for many TPAs. Freeing up time for TPA employees can lead to improved customer services, operations, and better cost-efficiency overall. In this blog, we’ll be exploring what AI virtual agents are and how you can use them to improve your business processes.
The Role of AI in Benefits Administration
What are AI Virtual Agents?
Virtual agents are software programs or cloud services that use artificial intelligence (AI) to provide automated services or guidance to humans. Many organizations are already using these agents to augment their customer service operations. They can answer common customer questions and handle simple problems. However, TPAs can also use these agents to streamline data processing, speed up claims handling, and more.
What aren’t AI Virtual Agents?
The description above may make you think of a chatbot. But, virtual agents are different from chatbots. Virtual agents are more advanced and able to understand and simulate human conversation. They can even understand user intent within the context of the conversation. By comparison, chatbots are relegated to their scripted rules. This makes chatbots a less powerful option.
It’s also important to note that AI virtual agents are not standalone tools. They are integrated into the other digital transformation tools shaping the TPA industry.
Key Pain Points AI Agents Can Solve
TPAs deal with countless amounts of data points every single day. Processing this data is a time-consuming operation, and can take valuable resources away from other areas of the business. AI agents can help streamline these tasks. They’re able to:
- Extract and process data from PDFs and Excel documents
- Upload data to platforms like Wex and Alegeus
- Assist with manual tasks like scrubbing data from PDFs and Excel documents
- Automate the complex processes surrounding enrollment
- Reduce errors in and speed up claims handling
Key Benefits for TPAs
By solving these key pain points, AI agents offer a range of benefits for TPAs.
Streamlined Invoicing
For many TPAs, invoicing takes up a large amount of time. The cumbersome process usually involves extensive manual work, including sifting through complex spreadsheets, managing ACH returns, verifying fees, and sending hundreds of individual emails requesting payment. This slows down the invoicing process and can lead to thousands of dollars tied up in unpaid invoices.
Using AI and automated systems, you can cut down on the time it takes to invoice. In fact, a large TPA switched to our Consolidated Invoicing solution, saving days of manual work and reducing errors. The software integrates directly with the benefits administration system. It pulls all necessary accounts and data, applies any recurring or one-time fees, and generates detailed invoices to share in a secure white-labeled employer portal for prompt payment. Using this solution, the company was able to move from a quarterly invoicing system to monthly invoices, which improved cash flow. Learn more about the company’s journey here.
Automating Claims Review and Record-Tying
The virtual agent can automate claims review and record-tying, which reduces processing times and improves accuracy with automated workflows. The agent can quickly cross-reference submitted claims against plan rules, eligibility criteria, and documentation requirements. This ensures only valid claims move forward in the process, reducing the need for manual intervention and minimizing errors.
HIPAA Compliance
Virtual agents also have built-in safeguards for HIPAA-compliant, secure data handling. Data is not added to agents unless consented to.
Enrollment Data Processing
AI simplifies data extraction and uploads for platforms like Wex and Alegeus. Agents can extract key information from claims forms and input them into your claims processing system. You’ll eliminate time-consuming data entry tasks and reduce the risk of human error. Learn more about how it works in our 15-minute webinar.
Enhanced Communication
Virtual agents use automated chat and decision trees to address customer inquiries. This helps provide instant responses to common questions. It’s great for scalable customer support, especially during peak periods. Your team no longer has to struggle to keep up with the volume of inquiries. Additionally, the predefined decision trees ensure consistent and accurate responses every time. This minimizes the risk of human error and reinforces trust in your communication process.
Additionally, virtual agents can assist with efficient outreach. 85% of employees are confused about their benefits. Sending regular updates and tips can help you keep this audience engaged and promote the correct use of benefits. Great engagement can even encourage employers to stay with you long-term.
However, continuous outreach has always been a challenge for TPAs. It involves spending hours downloading data from benefits admin systems, scrubbing that data in Excel, and segmenting people for email sends. But, it doesn’t have to be that way anymore. TPA Stream Communications allows you to take data within TPA Stream and connect it to our systems that are already integrated with the program. With this powerful connection, you can build segments and automatically send emails without much user intervention. Learn more about how it works in our in-depth blog.
TPA Stream’s AI Agent Tool Helps You Streamline Your Operations
At TPA Stream, we understand that automation and AI can seem intimidating. That’s why our AI virtual agents are designed to work seamlessly alongside your team, keeping sensitive data and complex workflows streamlined. With our systems, you can provide automated chat and decision trees for common inquiries, streamline claims review, record-tying, and scrubbing, and more. If you’re ready to explore what TPA Stream can do for you, reach out to us today. You can sign up for our AI Agent Tool pilot program launching January 2025 or attend one of our ongoing webinars to stay up-to-date on our offerings.
About TPA Stream
TPA Stream was founded in 2014 with the mission to make health benefits easier for employees and administrators. One of our co-founders, Eric, created this custom product to solve his own issue. He was working for an employer that changed its benefits package, which included a pretax account to pay for out-of-pocket medical expenses. In order for the employees to take advantage of this benefit, they were required to send all their claims to a TPA for processing and to Eric for reimbursement.
Eric started collecting his claims manually, but the process was prone to errors and delays. Instead, he wrote software to collect and submit his claims to the TPA. From there, the vision for TPA Stream was born.
What makes us different is that our programs were designed by someone who experienced the issue faced by many TPAs today. Using this real-world experience, we created a powerful tool that helps businesses like yours save time and money. We’d be honored to help you revolutionize your experience.