For third-party administrators, growth has always come with a catch: more covered lives means more provider calls, and more provider calls means more staff, more square footage, more IT overhead, and more management just to keep pace. Acuity Group, a TPA managing benefits for tens of thousands of covered lives across multiple employer groups, hit that wall head-on.
Eligibility checks. Benefits questions. Claims status. These are the bread-and-butter calls that flood a TPA’s call center every day: repetitive, transactional, and utterly necessary, yet they were consuming staff capacity that Acuity needed for growth. The math was simple and unforgiving: the company couldn’t scale to serve new clients without physically scaling its call center, and physically scaling a call center is slow, expensive, and hard to reverse.
So Acuity turned to EHVA, a conversational phone AI platform built by telecom and call-center veterans, to see whether an AI voice agent could take on the load.
A Narrow, Deliberate Scope
Rather than attempting to automate everything at once, Acuity and EHVA drew a tight boundary around the deployment. The AI would handle eligibility, benefits, and claims inquiries: the high-volume, highly structured calls where accuracy matters but the questions are predictable. Member services and prior authorizations, which require more judgment and carry more risk, were deliberately kept out of scope and routed to live staff.
That discipline turned out to be the deployment’s biggest strength. By narrowing the AI’s job to what it could do reliably, and pulling real-time data from Acuity’s systems for every call, EHVA was able to answer provider questions the same way an experienced staffer would, using information updated daily, and hand off anything outside its lane without a caller ever noticing friction.
Compliance was built in from day one: HIPAA-aligned handling of protected health information, controlled access to eligibility and claims data, full call logging for auditability, and SOC2 datacenter compliance. For a regulated business handling sensitive health data, that wasn’t a nice-to-have, it was table stakes.
The Numbers
In its first formal production assessment, covering 16,471 covered lives and roughly 13,500 monthly calls, EHVA resolved 81% of in-scope provider calls entirely on its own: no transfer, no hold, no human touch. The remaining 19% escalated to live staff, exactly as designed for the edge cases that need a person. The assessment included after-hours calls, meaning a meaningful chunk of that 81% represents service Acuity simply couldn’t have offered around the clock before.
Zoom out to account for every inbound call, including the categories intentionally left out of scope, and EHVA still autonomously resolved about 71% of total call volume, with a clear path past 80% of gross calls if Acuity chooses to bring member services into scope down the line.
For a business that was capacity-constrained by its own walls, that’s not an incremental efficiency gain. It’s a different growth ceiling entirely.
What It Sounds Like in Practice
Real calls handled by EHVA’s voice agents show the range of what “in scope” looks like day to day: a provider checking the status of a submitted claim and getting a real-time answer with no transfer; a provider verifying a member’s eligibility and benefits by pulling live data straight from Acuity’s database; a caller asking about deductibles and copays and getting answers pulled from that member’s actual accumulated benefits; a provider asking about a paid claim and getting the amount and date on the spot. In each case, the call resolves without ever reaching a live representative.
The Bottom Line
“Working with EHVA has been transformative,” said Tyler Reeves, Chief Operating Officer at Acuity Group. “Innovative solutions and visionary thinking have carried us to new levels of success.”
That sentiment tracks with the results: an 81% autonomy rate on in-scope calls, 24/7 coverage, and a TPA that no longer has to choose between growing its book of business and rebuilding its call center to support it. For an industry where call volume scales linearly with covered lives, and where every new client historically meant every new hire, that’s the kind of unlock that changes what growth actually costs.
Most EHVA deployments go live within five days, and the company doesn’t lock clients into long-term contracts. For TPAs, benefit administrators, and health insurers fielding the same repetitive eligibility, benefits, and claims calls that once bottlenecked Acuity, the question isn’t whether AI can handle provider calls, it’s how much capacity is sitting on the table until it does.
Learn more about EHVA’s healthcare voice AI solutions at ehva.ai.