Clari-IQ Hub deploys a suite of autonomous agents to resolve specific clinical and operational gaps, while Nexus-HQ orchestrates these insights into complete, audit-ready workflows. Purpose-built for Medicare Advantage and Medicaid plans, our platform turns fragmented EHR data into immediate action for HEDIS gap closure, member engagement, and payment integrity.
Clari-IQ Hub deploys specialized, prebuilt agents to resolve technical point-challenges, while Nexus-HQ provides the orchestration layer needed to streamline entire payer operations. The result is a high-performance data ecosystem that reduces administrative friction and improves member outcomes through a system of action built for the future.
Multiple AI agents extract, structure, and validate provider contracts - interpreting complex contract language and automating payment calculations against contracted terms for healthcare payer automation.
AI-powered policy intelligence that transforms healthcare manuals, provider policies, and regulatory guidance into instant, source-cited answers. Policy-IQ helps teams interpret billing rules, and quality requirements faster while ensuring compliance and audit readiness.
One platform connecting every member data source to actionable intelligence - payer member analytics AI, HEDIS automation, GenAI summarization, and EHR integration for real-time risk stratification and value-based care analytics.
.svg)
Real-time gap status per HEDIS measure with numerator/denominator logic automated. Stars Rating impact simulation per gap for value-based care analytics platform reporting.
.svg)
Unified member profile aggregating claims, clinical, pharmacy, SDoH, and EHR data into a single longitudinal record - the payer member analytics AI hub.
.svg)
Ingests PDFs, faxes, HRS forms, and clinical letters. AI OCR extracts 15+ structured clinical fields and auto-matches to member record - critical for payer data platform completeness.
AI-generated member clinical summaries - explaining HEDIS gaps in plain language, identifying primary health risk factors, and recommending next best action per gap. Core to GenAI solutions for healthcare organizations.
.svg)
Member 360, HEDIS Gap Automation, OCR + Document Entity Extraction, GenAI Summarization, Natural Language Query, SDoH Integration and EHR / HL7 / FHIR Integration. No fragmented point solutions. No data silos.
Nexus-HQ's Integration Bus unifies every member data source - EHR, claims, pharmacy, labs, SDoH - into one real-time intelligence layer via HL7, FHIR R4, and open APIs.
Clari-IQ identifies anomalous billing patterns and flags improper payments before adjudication - powered by Nexus-IQ real-time rule engine and Extract-IQ document intelligence. Continuous learning adapts to emerging fraud vectors across all claim types.
Everything You Need to Know About Clari-IQ Hub
Talk to our team
Clari-IQ Hub delivers a suite of autonomous agents that are point solutions designed to handle specific, high-complexity tasks like medical necessity reviews and HEDIS evidence extraction. Nexus-HQ then orchestrates these agents into a complete System of Action, automating entire payer workflows from data ingestion to final audit-ready resolution.
Traditional analytics platforms tell you what happened; Clari-IQ Hub helps you resolve it. While legacy tools are retrospective and require manual follow-up, Clari-IQ Hub deploys a suite of specialized, autonomous agents - point solutions designed to handle high-complexity tasks like medical necessity reviews and HEDIS evidence extraction. By moving from passive charts to active agents, we turn reporting into real-time operational resolution.
Nexus-HQ utilizes industry-standard HL7 FHIR R4 APIs to connect bidirectionally with major EHR platforms, including Epic and Oracle Cerner. Our integration layer enables the seamless synchronization of clinical records, and lab results, directly into a unified Member 360 view. By maintaining high-availability connections, we ensure your clinical and operational teams have access to the current data required for audit-ready decision-making, all while maintaining full HIPAA compliance.
Member 360 is Nexus-HQ's digital twin - a unified member profile that aggregates claims, EHR clinical data, pharmacy/Rx, SDoH, and HRS form data into a single real-time longitudinal record. It enables real-time risk stratification, HEDIS gap identification, and AI-generated clinical narratives, helping health plans reduce PMPM costs and improve Star ratings.
Yes. Clari-IQ Hub and Nexus-HQ are HIPAA compliant, SOC 2 Type II certified, ISO 27001 certified, and HITRUST certified. All AI agent responses are grounded in official CMS and state Medicaid sources. Every output is traceable and audit-ready. The platform is cloud-native and runs on Azure, AWS, or GCP with end-to-end encryption.