ChatGPT and the implications of AI for benefits administration

ChatGPT For Benefits Admin

What is ChatGPT?

Last week, ChatGPT set tech Twitter on fire with the release of a new AI chat tool that uses an advanced artificial intelligence program that is able to generate human-like responses to natural language queries. It is designed to provide helpful and accurate information on a wide range of topics, from general knowledge to specific subjects like technology and science. Within a few days after its launch, more than a million people were using it. And while there’s been some criticism of truly how smart it is, we couldn’t help but wonder: how could technology like AI help improve the work that TPAs are doing, specifically in the case of debit card substantiation? 

How can AI technology like ChatGPT help with benefits administration?

Debit cards are an increasingly popular payment method for qualified FSA expenses, as they offer a convenient and secure way to pay for medical and other eligible expenses. However, the process of substantiating these expenses can be challenging for third party administrators (TPAs), who are responsible for ensuring that claims are valid and eligible for reimbursement.

One of the biggest challenges TPAs face is the limited capabilities of the basic algorithms used by benefit administration platforms. These algorithms are not always able to accurately verify the legitimacy of claims, resulting in a high rate of debit card declines for qualified FSA expenses.

But this could change with the introduction of advanced artificial intelligence (AI) technologies, such as ChatGPT. ChatGPT is a cutting-edge AI platform that uses natural language processing and machine learning to understand and interpret the context, which is a primary challenge with substantiation. 

To be clear, ChatGPT is a chat tool, and as discussed earlier in this article, it has its limitations. AI technology for claims substantiation is not yet on the market and ChatGPT is not for this purpose. However, technology like this could provide more accurate and comprehensive substantiation of claims, increasing the percentage of debit card transactions that are automatically substantiated and reducing documentation requests for FSAs. 

One of the key benefits of ChatGPT is its ability to understand and process complex claims that may be difficult for traditional algorithms to interpret. For example, if a claim includes multiple expenses that are related to a single event, ChatGPT is able to understand the context and determine whether the expenses are eligible for reimbursement. This can help TPAs avoid unnecessary declines, which can save time and resources and improve the overall claims process.

Another benefit of ChatGPT is its ability to learn from past claims and experiences. As it processes more and more claims, it continually updates its understanding of the rules and regulations surrounding qualified FSA expenses. This allows it to provide more accurate and up-to-date substantiation, further reducing the rate of debit card declines.

In addition to improving claims substantiation, ChatGPT can also help TPAs reduce the time and resources they spend on manual review and verification of claims. By automating much of the process, ChatGPT can free up TPAs to focus on more complex and high-value tasks, such as identifying and addressing fraud and abuse.

Overall, the use of ChatGPT and other advanced AI technologies has the potential to dramatically improve debit card substantiation and reduce debit card decline rates for qualified FSA expenses. By providing more accurate and comprehensive substantiation, these technologies can help TPAs save time and resources, and improve the overall claims process for their clients.


Here’s the kicker: this article was written entirely by ChatGPT as a test for its capabilities (with the exclusion of the introduction, bolded section, and this conclusion). Pretty cool.

At TPAStream, we’re constantly looking for ways to help our customers deliver next generation benefits through the use of technology. We’ve improved substantiation rates for many of our customers by an additional five to ten percent with Claims Harvesting. This has helped them get closer to fully automated claims substantiation than they ever could before. In the world of third party administration, these gains add up to big improvements in their daily workflows and margins. 

We’re excited about the opportunity that AI technology like ChatGPT offers across many industries, and will continue to explore how this can impact our industry.

Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better benefits by connecting systems, transforming data, and helping TPAs unlock more revenue.

Learn more about TPA Stream here.

Let's Connect