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Claims, eligibility, provider, and network data live in one place, so nobody reconciles three systems to answer one question.
Core Administrative Processing SystemHealthOS CAPS: Care Administration
HealthOS CAPS: Care Administration
Built to Move at Claims Speed
Built on the proven foundation of AxisCore, HealthOS CAPS is the next generation of intelligent claims administration. By unifying six operational areas and letting AI PASS automate the routine work, it frees your team to focus where human judgment actually matters.
HITRUSTSOC 2 Type IICMSHL7 FHIR
Claims QueuePrior AuthMembersProviders
Claims MTD8,447
Clean Rate93.6%
In Review412
CLM-4421 · $2,480.00Auto-adjudicated
PaidCLM-4419 · $860.50Coordination of benefits
ReviewCLM-9920Duplicate billing detected
HoldAIAI PASS auto-adjudicated 214 clean claims this hour and flagged 3 for coordination-of-benefits review.
Running on the AxisCore engine, upgraded for HealthOS
Workspace Overview
What Is HealthOS CAPS?
HealthOS CAPS is the core administrative processing system at the center of HealthOS: the single workspace where claims adjudication, eligibility, provider management, and network operations run on one shared data core, with AI PASS embedded to clear repetitive work before it reaches your team. Whether you're a health plan, a TPA managing delegated business, or a provider group taking on risk, CAPS gives you one system built around how core administration actually works.
Shared Data Core
Every other HealthOS workspace reads and writes to the same live core. No exports, no nightly syncs.
AI PASS Does the First Pass
Clean work clears itself. Exceptions land on a reviewer's desk with the reasoning already attached.
Platform Foundation
Built on AxisCore. Evolved Into HealthOS CAPS.
AxisCore earned its reputation over six decades as a reliable core administrative processing engine built to handle real health plan volume. It was never just a database, it was the orchestration layer underneath claims adjudication, enrollment, provider management, and financial coordination, running as a single, immutable source of truth. HealthOS CAPS keeps that engine and takes it further: the same architecture and security posture, now wired with AI PASS and connected to the five other HealthOS workspaces that used to mean five extra logins.
AxisCore — The Proven CAPS
A unified, cloud-native core administrative processing system engineered to handle modern health plan volume. Not a database. An orchestration engine.
HealthOS CAPS — The AI-Native CAPS
The same orchestration engine, now on HealthOS's shared data core, with AI PASS embedded across every workflow and Plan, Provider, Member, Enrollment, and Sentinel connected around it.
Cloud-Native Architecture
AxisCore's foundation, rebuilt on microservices for zero-downtime scaling across all six HealthOS workspaces.
Immutable Security
The same enterprise-grade encryption and SOC 2 Type II compliance built into the core layer, now the security baseline for the entire platform.
AI PASS Embedded Intelligence
Agentic AI woven directly into the orchestration engine, clearing clean work and routing exceptions to a reviewer in real time.
Inside CAPS
Six Modules. Every One Built Around a Job, Not a Database Table.
Pick a module to see what your team actually touches inside it.
Member Administration
Member 360 turns five systems' worth of history, eligibility, claims, complaints, and billing into one record, so nobody has to ask a member to repeat themselves.
MembersMember 360 ProfileCare ManagementMember BillingComplaints & Grievances
Active Members47,855
New This Month312
Eligibility Holds14
Member #88213Eligibility confirmed
ActiveMember #88250Documentation required
HoldEnrollment batch · 312Daily eligibility feed
ProcessedHow Work Moves
What Happens in the Seconds After a Claim Hits CAPS.
The same path runs for authorizations, eligibility checks, and provider updates. Most of it, your team never sees.
A claim, authorization, or eligibility request lands in CAPS from a provider, a member, or a batch feed.
AI PASS checks it against eligibility, benefits, and policy and clinical edits before anyone has to.
Clean, criteria-matched work clears itself. Anything ambiguous gets routed, not buried.
A reviewer sees AI PASS's reasoning already attached and makes the call in seconds, not minutes.
The outcome updates the member, provider, and plan record everywhere at once, with a full trail behind it.
The Intelligence Layer, Inside CAPS
AI PASS Runs Inside Every CAPS Queue, Not Next to It.
AI PASS scores every claim, authorization, and eligibility check the second it enters CAPS. What's clean clears itself. What's ambiguous lands on a reviewer's desk with the reasoning already attached.
Learn more about AI PASSLive decision intelligence● Active
Claim CLM-4419 · $860.50Flagged01 / Review
Analysis completeEligibility verified · Benefits matched · Secondary coverage detected: coordination of benefits required before payment.
RecommendationRoute to COB reviewer with the secondary payer record attached.
Confidence 96%
Why HealthOS CAPS?
The Numbers Behind the Console.
What health plans, TPAs, and provider groups typically see after moving core administration onto CAPS.
70%+Faster Cycle Time
91%First Contact Resolution
50%Fewer Manual Touches
20–40%Operational Excellence
Why CAPS
What Changes When Care Administration Runs on CAPS.
The difference shows up in the parts of the job nobody wants to do twice.
The Old Way
- Your team re-keys the same member and provider data into three different systems, every time.
- Clean claims sit in the same queue as the complicated ones, waiting their turn.
- Credentialing status, contract terms, and directory listings live in trackers that never quite agree.
- Audit season means reconstructing who did what, and when, from memory and email threads.
- Adding a new workflow means a new implementation project, a new vendor, a new login.
On CAPS
- Member 360 and Provider 360 are the single source. Every module reads from the same record.
- AI PASS clears clean claims and routine authorizations the moment they qualify, no waiting in line.
- Provider, network, and contract data update in one place and show up everywhere else instantly.
- Every automated and manual action logs itself. Audit prep starts from a record, not a reconstruction.
- CAPS already shares a data core with Plan, Provider, Member, Enrollment, and Sentinel. Adding one is a configuration, not a project.
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.
What is HealthOS CAPS?
HealthOS CAPS is the care administration workspace inside HealthOS. It's where claims, eligibility, member, provider, and network operations are administered day to day, on the same live data core as every other HealthOS workspace.
Is CAPS the same as AxisCore?
CAPS carries forward HealthAxis's foundational AxisCore engine, the same cloud-native orchestration layer and immutable security model, and rebuilds it as an AI-native workspace inside HealthOS, now sharing a data core with Plan, Provider, Member, Enrollment, and Sentinel.
Can I deploy CAPS on its own?
Yes. CAPS works as a standalone workspace and connects to the full HealthOS suite whenever you're ready, without a re-implementation later.
How does AI PASS work inside CAPS?
AI PASS scores and routes work as it enters CAPS, clearing clean transactions automatically and sending anything ambiguous to a reviewer's queue with supporting evidence attached.
What modules are included in CAPS?
Member Administration, Clinical, Provider Administration, Network & Contracts, Plan Operations, and System Administration.
Is CAPS secure and compliant?
Yes. CAPS aligns with HIPAA, HITRUST, SOC 2 Type II, and CMS requirements, with role-based access control and a complete audit log across every module.
One Console, One Suite
Six Workspaces. One Record.
Every HealthOS workspace reads and writes to the same core. Start with CAPS, connect the rest whenever your team is ready.
Get Started
See HealthOS CAPS 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.
