Health plans

One technology. Many payer workflows.

Health plans pay providers. Providers deliver care. Members get what they are eligible for.

Request a Demo How it works

15
Production AI agents: 48+
Payer use cases: 97%
Manual time removed: 12:1
ROI multiple

Solutions

Packaged outcomes.

All solutions

DualEnroll.ai

Dual-eligible enrollment, end to end.

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PayerHealth CLM

Network contracts, machine-readable.

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Managed Medicaid

Medicaid operations without the drag.

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SDoH Intelligence

Social risk, scored and acted on.

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Technology

The components behind them.

All technology

Document Intelligence

Any page in, cited data out.

How it works

Voice & Conversational AI

Voice and chat in 10 languages.

How it works

Propensity & Recommendation

Who to reach, and how.

How it works

Eligibility & Compliance

Rules as code, with an audit trail.

How it works

Analytics & NLP Assistant

Ask the book of business a question.

How it works

Workflow Orchestration

Agents that finish the job.

How it works

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Score a member. Pick the channel.

Move the signals the way your book of business actually looks. The DIS score re-weights in real time and routes the member to the cheapest channel that still converts.

Eligibility signal strength78 · weight 30%
State file + claims evidence of dual / LIS qualification
Contactability62 · weight 20%
Valid phone, recent inbound, preferred-language match
Prior engagement40 · weight 15%
Opened, answered or completed a step before
SDoH burden55 · weight 20%
Transport, food, housing and language barriers on file
Deadline pressure70 · weight 15%
Recert window, SEP or plan-year boundary approaching

DIS propensity score

63/ 100

Tier 2 — AssistedAva voice + document capture

Strong signal, some friction. AI voice completes the screening and collects what's missing.

Illustrative model. Production DIS is trained on your own claims, state files and outreach history, and every score carries the features that produced it.

Fits your stack

We meet the systems you already run.

Integration model

Clinical record exchange
Network transactions
Health Cloud CRM
Claims & analytics
Core admin
Payments & pricing
Plan data warehouse
Voice & messaging
Contract execution
Azure tenant deploy

Coming soon

On the roadmap.

Two engines, new audiences. Both already have a date and a regulation behind them.

Network outreach

Voice outreach with document capture

Flip the audience. Ava calls the provider office to chase records and attestations; DocsIntel reads whatever comes back. One workflow, both engines — and a second buying centre across your network.

Outbound voice to network offices
Records and attestations captured on return
Structured, cited output into your systems

CMS-0057-F · Jan 2027

Payer-to-payer onboarding continuity

When a member switches in, DocsIntel converts legacy unstructured records into FHIR while DualEnroll runs the welcome call and captures the gaps — integrated with the major platforms for a seamless end-to-end flow.