Healthcare AI Agents
AI-powered member eligibility tool designed to streamline member enrollment and verification processes for Medicaid and commercial health plans. EnrollIQ intelligently analyzes and validates required eligibility criteria based on CMS guidelines and state specific rules. Through a fast, conversational interface, users can verify member status, resolve enrollment discrepancies, and ensure compliance with regulatory requirements.
Leverages multiple AI Agents automatically extract, structure, and standardize key terms from unstructured provider contracts. It not only interprets complex contract language but also performs automated payment calculations to validate billed amounts against contracted reimbursement terms (e.g., DRG rates, percent of Medicare, fee schedules).
AI-powered retrieval system that extracts and delivers precise billing guidance from official Medicaid manuals through a fast, conversational interface. Users can ask natural-language questions about billing codes, procedures, and reimbursement policies and receive accurate, traceable answers linked directly to the original source for audit-readiness.
AI agent designed to transform customer and staff support experiences. By leveraging historical ticket data and knowledge base, SupportIQ delivers fast, accurate, and context-aware answers to common questions—reducing response times and decreasing tickets. When resolution requires human intervention, SupportIQ automatically creates and routes new tickets with all relevant context. SupportIQ enhances efficiency, lowers operational burden, and ensures consistent, high-quality support interactions.
AI-powered agent built to streamline healthcare coverage navigation. Care IQ leverages healthplan documents including benefits handbooks, EOCs, claim policies, and more to delivers fast, accurate, and source-cited answers to common questions about coverage, deductibles, eligibility, claims processes, and cost-sharing responsibilities. Ideal for patients, providers, and care coordinators alike, CareIQ reduces administrative friction and empowers confident decision-making by making complex plan language easily understandable.
Generative AI-powered resource navigation module designed to help patients, providers, and care coordinators quickly identify and connect with relevant programs, services, and benefits based on a patient’s medical conditions, demographics, and social determinants of health (SDoH).
Reduction in improper
payments
Reduction in
administration costs
Reduction in delayed
or denied claims
Increased CAHPS/Provider
satisfaction scores