Solutions
Four ways payers put the substrate to work.
Packaged outcomes — enrollment, contracts, Medicaid operations, social risk. One grounded technology, deployed in your tenant.
Across the portfolio
Four solutions. One measurable line.
- 3.4×
- Higher enrollment conversion
- 70%
- Faster contract cycle time
- 60%+
- Manual touches removed
- Renewal rate
- 94%
- Higher conversion
- 3.4×
- Lower cost per enrollment
- 62%
Live in production
DualEnroll.ai
Find the coverage the member already qualifies for
DualEnroll.ai is the production system behind dual-eligible growth: it screens every member against Medicaid, LIS/Extra Help, MSP and SNAP rules, scores intent, and drives the packet all the way to an accepted submission — then keeps it alive through recertification.
- Real-time eligibility and secondary coverage discovery
- OCR intake for cards, IDs, appeals and consent packets
- DIS propensity score routes each member to the right channel
- Voice + chat in 10 languages, 24/7
What changes
- — Eligible-but-unenrolled members found before the competition finds them
- — Applications submitted complete the first time
- — Recertification handled before the coverage lapses
- Faster cycle time
- 70%
- Obligations tracked
- 100%
- Untraced amendments
- 0
New platform
PayerHealth CLM
The paper that governs the money
PayerHealth CLM governs every network, vendor and delegated agreement from first draft to renewal. Rates, fee schedules and obligations come out of the paper as structured data on day one, so the contract and the claim finally agree.
- Clause library with fallback positions and approval matrices
- AI redlining against your playbook, not a generic template
- Rate and fee-schedule extraction wired to claims adjudication
- Obligation tracking, amendment lineage and audit-ready trails
What changes
- — Rate terms machine-readable the day they are signed
- — Redlines measured against your playbook, not a generic template
- — Every obligation owned, dated and monitored
- Manual time removed
- 97%
- Template governance
- 50 st.
- Coordinated outreach
- 4 ch.
Multi-state
Managed Medicaid
Redeterminations that do not shed the member
A multi-tenant operations engine for Medicaid MCOs: state-specific template governance, feed ingestion without code, pre-filled recertification and coordinated print, email, SMS and voice cadences that hold members through redetermination.
- Multi-tenant, per-state template governance
- Payer feed ingestion and field mapping without code
- Pre-filled recertification and status tracking
- Print, email, SMS and voice in one cadence
What changes
- — Redetermination campaigns approved and evidenced per state
- — Exception queues with named owners instead of spreadsheets
- — Churn risk stratified before the notice goes out
- Star rating lift
- +0.3
- Churn reduction
- 26%
- Whole-person record
- 1 view
Whole-person
SDoH Intelligence
Close the gaps that move Stars
SDoH Intelligence turns claims, call transcripts, forms and geography into a stratified social risk profile, captures Z-codes, and closes the loop with community resources that actually have capacity.
- Z-code capture and structured SDoH coding
- Community resource matching with closed-loop referral
- Health equity index and stratified gap reporting
- Feeds care management and Stars measures directly
What changes
- — Social risk detected from data you already hold
- — Referrals tracked to an outcome, not a hand-off
- — Equity and Stars reporting that stands up to review
Why plans switch
Same team. Different numbers.
Twelve vendors, one member, nothing agrees
One substrate across every line of business
Answers no one can trace six months later
A citation and an audit entry on every action
Each new workflow is a new project
New workflows configured, not rebuilt
Outreach priced per touch
Propensity routing to the cheapest channel that converts
Bring us a workflow. We will show you the audit trail.
Ninety minutes with your operations and compliance leads. You leave with a mapped workflow, a measured baseline and a deployment path.