Skip to contentEmbedded, Not Bolted On
AI PASS runs inside CAPS, Plan, Provider, Member, Enrollment, and Sentinel, not as a separate app.
The Intelligence LayerAI PASS: The Agentic AI Workforce
AI PASS: The Agentic AI Workforce
Running Underneath HealthOS
AI PASS observes, understands, predicts, and recommends across every HealthOS workspace in real time, scoped to what each one actually needs, so your teams act on the next step instead of searching for it.
HITRUSTSOC 2 Type IICMSHL7 FHIR
Activity FeedModelsGovernance
Decisions Today48,210
Auto-Cleared91%
Routed to Review9%
CAPSAuto-adjudicated 214 clean claims
ClearedPlanFlagged 42 likely HCC gaps
FlaggedSentinelHeld duplicate billing, $4,200
HoldAIAI PASS is currently active across all 6 HealthOS workspaces, with every decision logged for review.
Distinct from NOVA, HealthAxis's omnichannel contact center
Platform Overview
What Is AI PASS?
AI PASS is the operational intelligence engine embedded across all six HealthOS workspaces. It’s built around five core capabilities — natural language processing, predictive analytics, decision intelligence, generative AI and automation, and a shared knowledge graph — working from one consistent view of every member, provider, and claim.
Explainable by Design
Every recommendation comes with the reasoning behind it, so staff can verify rather than trust blindly.
Governed, Not Autonomous
A tripartite model of people, agents, and oversight keeps every automated decision reviewable.
Platform Foundation
One Engine, One Shared Knowledge Graph, Six Workspaces.
AI PASS isn’t a model sitting next to your systems. It runs inside the HealthOS data core, which means it works from the same live member, provider, claim, and encounter record every workspace already uses — and inherits the same security and audit posture as the rest of the platform.
Immutable Security & Audit
Every AI PASS decision, flag, and recommendation is logged, supporting HITRUST and SOC 2 Type II obligations by default.
Shared Data Core
One knowledge graph connects members, providers, claims, and encounters, so context stays consistent across every workspace.
Agentic Digital Workforce
Configurable AI agents execute routine work end to end, escalating to a person whenever confidence or policy requires it.
The AI PASS Platform
Five Capabilities. One Engine.
Pick a capability to see what it actually does.
Natural Language Processing
Clinical notes, appeal letters, provider correspondence, and member messages are read and structured automatically.
Clinical Documentation ParsingMessage InterpretationMulti-LanguageStructured Extraction
Documents Parsed MTD112,400
Accuracy97.8%
Languages Supported14
Appeal Letter AP-441Parsed & routed
ProcessedClinical Note CN-118Structured data extracted
ProcessedMember Message MM-902Interpreted, benefit question
AnsweredHow Work Moves
The Same Five-Step Loop Runs Underneath Every Workspace.
Observe, understand, predict, recommend, learn.
AI PASS continuously reads activity across claims, eligibility, provider, and member data as it happens.
Structured and unstructured data is interpreted in context, using the knowledge graph connecting every record.
Outcomes are forecast, from claim risk to care gap likelihood to Star measure impact.
The next action is surfaced to a workflow or a person, with the reasoning behind it attached.
Outcomes feed back into the model, so accuracy improves as more decisions are made and reviewed.
Decision Intelligence
Every Recommendation Comes With Its Reasoning Attached.
AI PASS never returns a bare score. Each decision carries the evidence behind it — what was checked, what matched, what didn't — so a reviewer verifies the logic instead of trusting a black box.
Live decision intelligence● Active
Claim CLM-48214Flagged01 / Review
Analysis completeEligibility verified · Benefits matched · Policy edit: non-covered service on this plan variant.
RecommendationRoute to reviewer with denial rationale attached.
Confidence 96%
Across the Platform
The Same Engine, Scoped Differently in Every Workspace.
AI PASS isn't a generic layer sitting on top of HealthOS. What it does changes depending on where it's working.
In HealthOS CAPS
Supports auto-adjudication, prior auth triage, and pre-payment screening, claim by claim.
In HealthOS Plan
Predicts HCC gaps and forecasts Star Ratings performance against current measure thresholds.
In HealthOS Provider
Runs continuous primary source verification and flags network adequacy gaps early.
In HealthOS Member
Answers benefit and claims questions in plain language, grounded in each member's actual record.
In HealthOS Enrollment
Predicts application drop-off and flags identity or document fraud signals on intake.
In HealthOS Sentinel
Detects duplicate billing, coding anomalies, and provider outliers before a claim pays.
Governance & Trust
A Tripartite Model: People, Digital Agents, and Oversight.
AI PASS is built around a tripartite digital workforce model rather than a fully autonomous one. Human staff, AI PASS agents, and a governance layer each play a defined role, and every automated decision is logged and reviewable.
Explainable by Design→Human-in-the-Loop by Default→Full Audit Trail→Scoped to Each Workspace
Why AI PASS?
The Numbers Behind the Engine.
What health plans, TPAs, and government programs typically see once AI PASS is running underneath their workspaces.
96%+First-pass accuracy
30+AI agents
20–40%Lower cost
2–3xProductivity gain
Why AI PASS
Bolted-On AI vs. an Embedded Engine.
The difference shows up the moment a decision needs context from more than one system.
Bolted-On AI
- A separate model is trained per system, so each one only sees a slice of the member.
- Recommendations arrive as a score with no explanation a reviewer can verify.
- Automation is all-or-nothing, so teams either over-trust it or switch it off.
- AI decisions live outside the audit trail your compliance team actually reviews.
On AI PASS
- One engine works from a shared knowledge graph spanning every workspace and record.
- Every recommendation carries the evidence and reasoning behind it.
- Thresholds are configurable per workspace, so your team sets where humans stay in the loop.
- Every automated and manual action logs itself in the same audit trail as everything else.
Security & Compliance
Built to the Standards Your Compliance Team Already Holds You To.
Role-based access control, encryption in transit and at rest, and a complete audit log across every module — the same baseline for every HealthOS workspace.
HITRUSTSOC 2 Type IINCQAHL7 FHIR R4CMS Interoperability RuleEDI 837 · 835 · 270 · 271
FAQ
Frequently Asked Questions.
Is AI PASS the same thing as NOVA?
No. AI PASS is the operational intelligence engine embedded across HealthOS workspaces. NOVA is HealthAxis's omnichannel contact center, an intelligent, multi-capability product that handles live member and provider conversations. They're connected but distinct products.
Does AI PASS make fully autonomous decisions?
AI PASS is built around a tripartite model of people, digital agents, and governance working together. Routine decisions within configured rules can run automatically, while ambiguous or high-impact decisions route to a person, and every decision is logged for review.
Can we configure what AI PASS automates versus what it flags for review?
Yes. Thresholds and automation rules are configurable per workspace, so your team controls where AI PASS acts automatically and where it routes to a human reviewer.
How does AI PASS handle data across six different workspaces?
AI PASS works from the same shared knowledge graph that connects member, provider, claims, and encounter data across HealthOS, so its understanding of context stays consistent no matter which workspace it's supporting.
One Console, One Suite
Six Workspaces. One Record.
Every HealthOS workspace reads and writes to the same core. Start with AI PASS, connect the rest whenever your team is ready.
Get Started
See HealthOS AI PASS in the context of your operations.
Bring your line of business and your hardest workflow — we’ll show you how it runs on one intelligent platform.
