AI powered platform
Insurance Eligibility & Enrollment Agent
AI agent automates Medicaid/Medicare eligibility determination and enrollment, verifying income, household data, and ACA criteria (e.g., 138% FPL in Maryland). Our solution integrates with State and Federal systems as needed
Eligibility Engine
Instant, accurate eligibility determination
Our AI agent quickly determines whether an applicant qualifies by analyzing household size, age, income, pregnancy status, and ACA criteria such as 138% FPL thresholds — in real time, without a call center.
Handles complex rules: income thresholds, age brackets, disability criteria
Integrates with State and Federal systems automatically
Reduces manual caseworker load by up to 80%
- Handles complex rules: income thresholds, age brackets, disability criteria
- Integrates with State and Federal systems automatically
- Reduces manual caseworker load by up to 80%
Challenge
- Confusing Eligibility Rules: Medicaid rules are difficult to understand—income thresholds, FPL %, age brackets, pregnancy rules, disability criteria, etc.
Our AI-Powered Solution
- Instant, Accurate Eligibility Guidance: AI agent quickly determines whether a user may qualify by analyzing household size, age, income, pregnancy, and other criteria
Document intelligence
Know exactly what documents to bring
Based on each applicant’s eligibility category, the AI agent generates a customized document checklist — no more confusion about what income proof, ID, or residency documents are required.
- Tailored per applicant profile and program type
- Plain-language instructions — no policy jargon
- Dramatically reduces dropout from form confusion
Challenge
- Real-time Guidance Deprivation: Users don’t know which documents they need and how income should be calculated
Our AI-Powered Solution
- Personalized Document Checklists: Based on eligibility category, the AI agent generates customized list of document needed for application
RAG + Semantic search
Automated, reliable policy interpretation
Policy PDFs are ingested and vectorized automatically. Our RAG + semantic chunking pipeline ensures the system always pulls the correct, current policy information — eliminating costly interpretation inconsistencies.
- New policy docs go live the moment they're uploaded
- No engineering work required for rule updates
- Audit trail for every interpretation decision
Challenge
- High Dropout Rate: Applicant dropout rates are high as the process is complex and not engaging enough for them to continue
Our AI-Powered Solution
- Automated, Reliable Policy Interpretation: RAG + semantic chunking ensures the system pulls the correct policy information, eliminating the possibility of interpretation inconsistencies
Problem-focused
Manual Reviews Are Slowing You Down
Every eligibility decision that depends on a human reading a policy document is a decision that can be delayed, misread, or made inconsistently. When caseworkers must repeatedly interpret the same rules across hundreds of applications, errors compound — and so do costs.
- Delays at every step - manual document review creates bottlenecks that slow down applicant processing
- Costly inconsistencies — different workers interpret the same policy differently, leading to unequal outcomes
- High training overhead — new staff must learn complex policy rules before they can process a single case
Challenge
- High Cost of Manual Reviews: Human workers must repeatedly interpret policy documents, resulting in delays and inconsistencies
Our AI-Powered Solution
- Easier Maintenance & Faster Policy Updates: Because policy PDFs are ingested and vectorized automatically, updating eligibility rules no longer requires extensive engineering work—new documents simply get uploaded
Scalable architecture
Built to scale at peak enrollment
LLM-powered workflows, vector search, and optimized pipelines reduce system load. The platform automatically scales during high-demand enrollment periods without caseworker bottlenecks.
- Handles 10× traffic spikes without degradation
- State & Federal API integrations built in
- 99.9% uptime SLA during open enrollment
Challenge
- Poor Scalability: Call centers and eligibility teams cannot automatically scale during peak enrollment periods
Our AI-Powered Solution
- Scalable, High-Performance Architecture: LLM-powered workflows, vector search, and optimized pipelines reduce system load and allow the platform to scale during peak enrollment periods
Not sure where to start?
Our team will guide you through the platform and tailor the solution to your state’s specific eligibility rules and system requirements.