Clari-IQ Hub is an AI platform for healthcare payers - including Medicaid managed care plans, commercial health insurers, and Medicare Advantage organizations. It combines GenAI agents for prior authorization, member analytics, EHR integration, and payer automation, plus Nexus-HQ for member intelligence, HEDIS automation, and risk stratification.

Policy-IQ answers prior authorization queries instantly by retrieving information from CMS guidelines and state Medicaid manuals, providing source-cited, audit-ready responses in seconds instead of hours. This reduces PA turnaround time by up to 85% and helps payers meet the CMS Prior Authorization Final Rule requirements.

Yes - Policy-IQ leverages prior authorization automation AI to handle workflows end-to-end for health plans, cutting review times by up to 70% and dramatically reducing administrative burden on clinical teams.

Unlike traditional payer analytics platforms that only report on what happened, ClariIQ Hub uses GenAI agents and Nexus-HQ member intelligence to take action - automating workflows, answering complex queries in natural language, and integrating bidirectionally with EHR systems in real time. Legacy tools offer batch-only risk stratification; ClariIQ runs live.

Nexus-HQ uses HL7 FHIR R4 APIs and an integration bus to connect bidirectionally with Epic, Oracle Cerner, Meditech, Athenahealth, and other EHR platforms. Clinical data, lab results, ADT alerts, and encounter records are streamed in real time into the Member 360 digital twin - with <200ms latency and full HIPAA/HITRUST 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. ClariIQ 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.