This page summarizes an analysis we conducted with one of our customers. The results surprised even us and demonstrated how much value TPAs can provide to their participants by automating processes.

The Data Set

We analyzed processing times for all claims submitted to a single TPA during the last 12 months. This includes web portal submissions, mobile submissions, and even file-based submissions such as fax and email.

Due to the seasonality of claims, with two peaks at the end of the year and the end of the runout period, it was important to capture and analyze a full annual cycle.

Since most claims are approved, and automation can speed up the approval process, we focused the analysis on the response time for approved claims.

The data covers:

• 209,000 approved claims
• 119,891 manually approved claims
• 89,461 Silver-automated approvals

There are three key insights from the data we analyzed.

1. Median Response Drops from ~2.5 Days to ~2 Hours

The data measured the time from when the participant last uploaded a document to when the claim was approved. Here is the comparison:

• Median: 60.31 hrs manually approved vs. 2.21 hrs with Silver (27× faster / 96% reduction)
• 90th percentile: 161.28 hrs manually approved vs. 7.27 hrs with Silver (22× faster / 95% reduction)
• Average: 79.62 hrs manually approved vs. 11.71 hrs with Silver (6.8× faster / 85% reduction)

The bottom line is that a typical participant waited about 2½ days to get their claim manually approved. With Silver automation, that drops to just over 2 hours.

This means that for most cases, the participant gets a reply within the same workday!

2. 10% of Participants Were Waiting for Almost a Week

In the data set we analyzed, the 90th percentile was ~6.7 days, approximately 12,000 claims and thousands of participants waited almost a week to get approved.

Once Silver was enabled, the 90th percentile went down to 7.3 hours.

That speaks directly to the claims that generate participant frustration, follow-up emails, calls, and “Where is my reimbursement?” questions. Silver significantly reduced this tension.

3. Automation Makes Claim Response Predictable

Perhaps more important than speed itself was consistency. Across an entire year, Silver’s median automated response time remained between roughly two and three hours. Manual response times fluctuated between one and four days.

For the sequential 12 completed months (including seasonal peak times):

• Silver automated median: 2.05–2.85 hours
• Manual median: 23.91–94.05 hours

Avoiding a Perfect Storm

The data showed what claim teams feel every December. Participants submit more claims, many claims take longer than expected to process, and support calls start to pile up.

Silver smooths this peak by automating the majority of claims and allowing processors to stay on top of the load, even during the holidays.

As a result, both participants and processors are less stressed.