The AI-native TPA for self-funded employers

Health plan administration, rebuilt as software.

Daybook Health runs claims administration, member support, and care navigation as one operating system. AI-native from day one — so automation is the foundation, not a retrofit bolted onto a legacy queue.

Book a meeting → See how it works

Now working with founding employer groups and their brokers

Backed by

ops.daybook.health/queue

Work queue

Meridian Mfg

Mon, Aug 18

Auto-resolved190

Median answer0:04

Human review1

Prior-auth status callMBR-1152 · Agent	Answered
New-hire eligibility fileELG-2231 · Agent	Verified
Clean professional claimCLM-0933 · $214.60 · Agent	Paid
Out-of-network facility claimCLM-0902 · $2,410.00 · Dana Kim	In review

Eligibility
Accumulators
Plan terms §7.4
COB

DK Dana KimLicensed examiner

How it works

One operating system, from first call to final payment.

Every claim, question, and exception moves through the same ledger — assembled by AI, decided by the right party, visible to the employer.

Intake

Calls, portals, and EDI feeds land in one queue. Eligibility and benefits questions get plan-grounded answers on the first contact.

Adjudicate

Clean claims auto-adjudicate. Exceptions arrive with context already assembled — COB, accumulators, plan language — not a blank screen.

Decide

Licensed humans make every medical-necessity and high-risk call. AI drafts and assembles; it never signs off.

Report

Employers see spend, utilization, and service quality continuously — not in a quarterly PDF two months after the fact.

Why the TPA layer

The administrator decides more than it admits.

Self-funded employers assemble healthcare from a stack of vendors: an administrator, a leased network, a stop-loss carrier, a PBM, and a growing shelf of point solutions. Every claim, every eligibility check, and every confused phone call passes through the administrative layer in the middle. Yet that layer is usually the least modern part of the stack, staffed around exception queues and call centers, processing care after it happens.

The administrator should be the intelligent part of the plan. When the system that pays the claims also answers the member's first question, it decides what happens next before money leaves the plan: which site of care, which pathway, what it will actually cost. That is Daybook Health — and it starts with getting the unglamorous work right. Eligibility. Adjudication. The phone.

Operating model

A thin TPA with a thick software layer.

Built for mid-market self-funded employers — 100 to 1,000 lives per group, starting in the Northeast. We license proven core infrastructure and put our engineering where employers feel it: the member front door, voice, exception automation, and reporting.

We build

The layer above the ledger.

The member and provider front door, AI-assisted voice and support, exception automation with context assembled before a human opens the file, and employer reporting that updates continuously. One system of record, everything connected over real-time APIs — no swivel-chair operations, no batch files where real-time is possible.

We license & partner

A buyer of everything below it.

A licensed claims platform as the system of record — not homegrown adjudication. National PPO network access, stop-loss coverage, and pharmacy benefits through established partners. We integrate best-in-class components under one brand rather than rebuilding them.

We hold the line

Humans decide what matters.

AI handles provider eligibility and claim-status calls, document intake, benefit explanations, and exception context-gathering. Licensed humans make every medical-necessity, denial, and high-dollar decision. A design principle, not a regulatory concession.

Design partners

Greenfield, and we play it openly.

No legacy operation, no migration debt, no decades of workarounds. We select every component of the stack in the open, hold our vendors to the same standard we hold ourselves, and scale with the partners — and the employer groups — who join us at the foundation.

Principles

How we operate.

Automation is the foundation.

Not a chatbot bolted onto a legacy queue. Every workflow is designed AI-first, from the ground up.

Judgment stays human.

Every medical-necessity and high-risk claims decision is made by a licensed person, with the context assembled for them.

The ledger is open.

Employers see what their plan is doing — spend, service, decisions — continuously, in reporting they can actually read.

Founding groups

Early groups get the administrator shaped around them.

Daybook Health works with a deliberately small founding cohort of employer groups and the brokers who advise them. Founding groups get white-glove implementation, direct access to the founding team, and a real voice in how the platform develops — the attention a 50,000-life book of business never gets from an incumbent.

If you advise self-funded employers, or run benefits for a company that is tired of the current experience, talk to us. The groups that join now are the ones we build around.

Contact

Founders answer this inbox.

Employer and broker conversations, platform and vendor introductions, or just a strong opinion about how a TPA should work. All welcome — and answered fast.

Book a meeting →

We came to healthcare from compliance software — an industry that also runs on plan documents, audits, and evidence, and where trust is won by doing the tedious work correctly for a long time. Daybook Health runs plan administration the same way: automation where it makes service faster and more consistent, licensed humans where judgment and accountability matter, and reporting an employer can actually read. And founders who answer their own email.

— The Daybook Health founding team