AI Agents for Eligibility, Prior Auth & Claims
Payer–provider automations with HIPAA guardrails, FHIR/HL7 + X12 awareness, and multilingual outreach. Specialized in reducing turnaround time and operational abrasion.
HIPAA compliance checks
100%
+0%
Auto-approved auths
62%
+5%
Prior-auth turnaround
4h 12m
-37%
Eligibility success
98.7%
+0.6%
Provider Ops
Verify eligibility, gather clinical criteria, submit 278 & receive notifier, schedule care.
PII redaction + audit trail
FHIR/HL7 + X12-aware prompts
Human handoff when needed
Payer UM/CM
Utilization management scripting; policy-aligned approvals; avoid abrasion with smart KBA.
PII redaction + audit trail
FHIR/HL7 + X12-aware prompts
Human handoff when needed
Member Outreach
Reminders, prep instructions, benefits guidance—ES/PT/EN, voice/chat/email.
PII redaction + audit trail
FHIR/HL7 + X12-aware prompts
Human handoff when needed