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We are very excited to announce the release of our AI Claim Agent. With Silver's AI Claim Agent, third-party administrators (TPAs) can now:

• Automate claim approvals and denials in seconds
• Cut processing costs by up to 50% without sacrificing accuracy
• Improve participants’ experience with real time claim responses

Manual claims processing is costly, time-consuming, and prone to errors. With Silver’s advanced AI and LLM-powered OCR technology, we’re enabling TPAs to make faster, smarter, and more efficient adjudication decisions while ensuring full compliance.

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Claim Processing is Expensive

TPAs must balance efficiency with participant experience, but the cyclical nature of FSA and HRA claims makes this incredibly challenging. Instead of taking a holiday break, claims teams work extra shifts on December 31st, while support teams put in long hours in March as the runout deadline looms and participants rush to use their remaining funds.

This process is costly and inefficient, with claim processing times ranging from a few minutes of manual review to days or even weeks for full resolution. Errors lead to compliance risks, delayed reimbursements, and frustrated participants. Traditional manual adjudication methods create bottlenecks, struggle to adapt to seasonal fluctuations, and drive up administrative costs.

Over the years, TPAs have attempted to integrate OCR and other automation technologies, but these piecemeal solutions have often failed to deliver the expected business outcomes—falling short on accuracy, adaptability, and overall efficiency.

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Automated Claim Processing is Here

Silver’s AI Claim Agent offers a unique approach to reducing claim processing cost. It follows three core principles:

• Minimize change management. Silver integrates with existing tools and workflows, minimizing transition costs and ensuring a smooth shift from manual to automated processing.
• Immediate ROI: TPAs experience measurable cost reductions within months, leading to increased profitability shortly after implementation.
• Controlled Progress: Silver’s AI and LLM-driven adjudication process is risk adverse and makes decisions only when it has concrete evidence. Over time, it learns from submitted claims and will act on a bigger portion of claims.

Silver integrates with the most common TPA platforms including both Wex and Alegeus, and reads claims submitted by participants. Once a claim is submitted, Silver executes a three-step AI-powered adjudication process:

1. Extract claim data – Using a fine-tuned LLM, it extracts all relevant data from receipts, EOBs and medical docs creating structured data from unstructured evidence. 
2. Determines expense eligibility – Leveraging a proprietary database of 5M+ SKUs and service codes built with AI, Silver verifies whether the expense qualifies for reimbursement.
3. Calculates the claimable amount – Silver identifies the actual out of pocket cost of the service or product, compares it to the plan’s policies and the requested claim amount, and determines the appropriate reimbursement.

For claims where Silver successfully completes all three steps, it adjudicates the claim and removes it from your team’s queue providing participants with a detailed response—ensuring speed, accuracy, and transparency. 

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Want to learn more? Schedule a demo with us to show you how Silver can help your team cut claim processing costs and streamline operations. Let’s explore how automation can drive efficiency for your organization!

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Let’s welcome more claims together

The success of Consumer-Directed Healthcare (CDH) programs depends on consumers' ability to file claims efficiently and TPAs' ability to process them effectively.

We believe that by combining technological advancements with Silver’s unique approach, the entire ecosystem can better integrate claims into existing workflows, leading to increased utilization of CDH programs. This, in turn, will allow more consumers to benefit from tax saving programs and reduce healthcare costs for everyone.
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