Claim Health vs Silna Health (2026)

Inside the agency's EMR, Claim Health monitors coverage, documentation and eligibility. It pulls referrals from fax, email and portals into one workflow, submits and renews prior authorizations, and posts payments and reconciles. Claim Health names none of the EMRs it works inside.

SourceClaim Health, claimhealth.comread 2026-10-06

Silna works with more than 1,000 payers across 50 states, calling insurers for benefits and authorization status and submitting through their portals. On the provider side it connects to the EHR and practice management systems ABA providers already use, CentralReach and Catalyst among them, so insurance work runs alongside the clinic's existing setup. The list of practice systems is short and centered on ABA platforms, and whether authorization results flow back into them is unclear.

SourceSilna Health, silnahealth.com, /aba-therapy, engineering.silnahealth.com/posts/autonomous-browser-agents-enterprise and /posts/building-phone-agents-healthcareread 2026-10-09

Coverage Assurance, Smart Intake, Authorization Autopilot and Billing Operations run the referral to reimbursement cycle for home based care providers as multi-step automated work (intake against criteria, authorization submission through renewal, posting, reconciliation and denial follow-up), with Platform Intelligence across them.

SourceClaim Health, claimhealth.comread 2026-10-06

The prior authorization lifecycle runs from expiration tracking and weekly reminders through form generation, submission and continual payer follow up. It branches as requests for additional information or resubmission raise alerts, denials move to appeal and Medicaid plan switches are flagged so authorizations can be resubmitted to the new plan. For ABA the same lifecycle covers initial assessments, concurrent reviews and reauthorizations. Behind it, document validation rules combine with AND and OR logic into configurations, and a graph decides which rules apply to each document type.

SourceSilna Health, silnahealth.com/prior-authorization, /insurance-monitoring, /aba-therapy and engineering.silnahealth.com/posts/document-validationread 2026-10-09

Work starts on its own when referrals arrive by fax, email or portal, when coverage lapses or documentation gaps appear in the EMR, when authorizations come due for renewal and when claims are denied or payments mismatch, with eligibility rechecked continuously.

SourceClaim Health, claimhealth.comread 2026-10-06

Work starts without staff: weekly expiration reminders, recurring eligibility and benefit checks, real time monitoring of every active patient's coverage, automatic detection of new insurance and Medicaid plan switches, and phone agents that call payers to check whether a submitted authorization was approved. For ABA, authorized hours remaining and upcoming reauthorization deadlines are tracked continuously so renewals go out before therapy is interrupted.

SourceSilna Health, silnahealth.com/insurance-monitoring, /prior-authorization, /aba-therapy and engineering.silnahealth.com/posts/building-phone-agents-healthcareread 2026-10-09

Referral packets are checked against the agency's own clinical criteria and OASIS fields are validated before submission, using the EMR data for each case. Claim Health describes no maintained retrieval structure over the customer's knowledge.

SourceClaim Health, claimhealth.comread 2026-10-06

Silna maintains an always current database of each payer's prior authorization requirements per specialty, kept by its Payor Intelligence team from payer bulletins and the thousands of authorizations it processes each week, and applies it to form generation and document validation so providers never track the rules themselves. Predictive Document Intelligence reads diagnosis reports, treatment plans and progress notes with multimodal models and checks them against those criteria before submission, ABA treatment plans and progress reports included, and Silna reports a 98 percent first pass acceptance rate for requests it validates.

SourceSilna Health, silnahealth.com/prior-authorization, /aba-therapy, /resources/best-prior-authorization-software and engineering.silnahealth.com/posts/document-validationread 2026-10-09

Claim Health describes no memory the agents keep for themselves, what it would hold or how long it would last. Referral, authorization and claim status live in the agency's EMR and billing workflow as its business records.

SourceClaim Health, claimhealth.comread 2026-10-06

What persists sits on Silna's side: the payer requirements database and the growing record of reviewer corrections that shapes later submissions. The agents work from those shared stores and each authorization's own record, with no memory of a clinic or patient that has its own scope or lifetime.

SourceSilna Health, silnahealth.com and engineering.silnahealth.com/posts/beyond-the-agentread 2026-10-06

Routine posting, reconciliation and follow-up are automated while exceptions are surfaced to the billing team for review before they are resolved, so teams handle only the exceptions rather than every claim, and intake gaps are surfaced before a referral proceeds.

SourceClaim Health, claimhealth.comread 2026-10-06

Staff stay in the loop where judgment matters. When document validation finds a gap against the payer's criteria, the provider reviews it and decides whether to update the documents or submit as they are, and requests for more information, resubmissions and appeals come back to the team as alerts. Behind the agents, Silna sends a set share of submissions to its own QA reviewers, who can override and correct the agent's work. Routine requests go out without staff touching each one, so there is no clinic sign off before a standard submission reaches the payer.

SourceSilna Health, silnahealth.com/prior-authorization, /resources/best-prior-authorization-software, engineering.silnahealth.com/posts/document-validation and /posts/beyond-the-agentread 2026-10-09

The platform is SOC II certified and HIPAA compliant, by Claim Health's account, and the company calls it privacy first. Claim Health names no single sign-on, roles or permissions for customers.

SourceClaim Health, claimhealth.comread 2026-10-06

Security starts with SOC 2 Type II certification through Vanta, operation under HIPAA and a pledge to treat patient confidentiality as a priority. On the agent side, each browser session is tied to a single provider through row level security, so one clinic's agent cannot reach another clinic's records. There is no single sign on or role management for a clinic's own staff.

SourceSilna Health, silnahealth.com and engineering.silnahealth.com/posts/autonomous-browser-agents-enterpriseread 2026-10-06

Platform Intelligence gives real-time visibility into every referral, admission and blocker, in a single view that shows leaders revenue risk, performance and impact across the organization. That view reports status. Claim Health describes no record of what the agents read, wrote or decided in each action.

SourceClaim Health, claimhealth.comread 2026-10-06

Clinics follow each authorization from submission to approval on a dashboard, with approvals passed along as they arrive. Inside Silna, every inference call and tool execution of a browser agent is saved as a pipeline step and each session gets a quality score from 0 to 100, a record that serves Silna's own engineers and reviewers. Clinics see status and outcomes rather than the agent's step by step trail.

SourceSilna Health, silnahealth.com/prior-authorization and engineering.silnahealth.com/posts/beyond-the-agentread 2026-10-06

The platform is hosted and works inside the agency's EMR. No hosting region is published, and Claim Health names no option to run in the customer's own environment.

SourceClaim Health, claimhealth.comread 2026-10-06

The service is hosted. Its browser agents operate in sandboxed sessions on Silna's own self hosted Kasm Workspaces deployment, which isolates each session from the next and keeps agent activity off the clinic's own machines. There is no region choice, customer cloud or on premises option.

SourceSilna Health, silnahealth.com and engineering.silnahealth.com/posts/autonomous-browser-agents-enterpriseread 2026-10-06

Coverage Assurance, Smart Intake, Authorization Autopilot and Billing Operations are modules of one revenue platform sharing one workflow, with Platform Intelligence on top. Claim Health does not say whether a module can be bought on its own.

SourceClaim Health, claimhealth.comread 2026-10-06

Silna sells one Care Readiness Platform built from prior authorizations, benefit checks, insurance monitoring and payor discovery, with prior authorizations priced at $35 each. These work as parts of one service rather than separate agents a clinic switches on, and there is no template or agent library. Customers include Behavior One Autism Solutions, Autism Learning Partners, ABS Kids, AnswersNow, HealthPro Heritage and Elite Alliance Physical Therapy.

SourceSilna Health, silnahealth.com and /resources/best-prior-authorization-softwareread 2026-10-09

Neither the model provider nor any model choice for customers is named.

SourceClaim Health, claimhealth.comread 2026-10-06

Models are picked for each payer portal after testing cost, context window, intelligence and speed, and production traffic can be split between models that perform equally, for example half to Haiku 4.5 and half to GPT 5.4. The phone agents use Deepgram for speech recognition and ElevenLabs for speech, and the customer has no choice of model.

SourceSilna Health, engineering.silnahealth.com/posts/beyond-the-agent and /posts/building-phone-agents-healthcareread 2026-10-06

There is no published API, SDK or MCP surface for Claim Health.

SourceClaim Health, claimhealth.comread 2026-10-06

Authorizations can be followed from submission to approval through an API as well as Silna's dashboard, which gives a clinic's other systems a way to track them. There is no public API reference, SDK or MCP server, and the agents themselves work through payer portals, payer phone lines and Silna's own app.

SourceSilna Health, silnahealth.com/resources/best-prior-authorization-softwareread 2026-10-09

Denial prediction works on the agency's claims, not on the agents, and Claim Health describes no way for customers to evaluate or test the agents. Claim Health reports 80% fewer manual hours, 15% more approved claims and a 3% EBITDA lift for its customers.

SourceClaim Health, claimhealth.comread 2026-10-06

An in house Experiments platform sets what share of prior authorizations each portal agent submits with no human touch and routes a share of agent submissions to human QA, comparing human and AI results, and specialist reviewers flag minor or major errors to build a dataset of where the agent was wrong. Models are tested per portal in a sandbox on production infrastructure for duration, token use and accuracy, and every session gets a score from 0 to 100 for execution quality, apart from its final outcome.

SourceSilna Health, engineering.silnahealth.com/posts/beyond-the-agentread 2026-10-06

Claim Health describes no browser or computer control.

SourceClaim Health, claimhealth.comread 2026-10-06

Browser agents work payer portals on their own, logging in with 2FA, navigating complex legacy interfaces, entering clinical data and recording approvals, across Blue Cross, Aetna, United and dozens of other portals, inside sandboxed browser sessions. They now handle nearly half of all prior authorizations and are trained to stop and ask for help rather than guess when stuck. Phone agents navigate payer phone menus to retrieve plan details.

SourceSilna Health, engineering.silnahealth.com/posts/autonomous-browser-agents-enterprise, /posts/beyond-the-agent and /posts/building-phone-agents-healthcareread 2026-10-06