Skip to contentPlain-Language Answers
Coverage and claim questions are answered against the member's real plan, not a generic FAQ.
Member Self-Service & EngagementHealthOS Member: Benefits Explained in Plain Language,
HealthOS Member: Benefits Explained in Plain Language,
Not Policy Language
Help members understand benefits, claims, pharmacy, and deductibles through self-service powered by AI PASS, drawing from the same live record every other HealthOS workspace uses.
HITRUSTSOC 2 Type IICMSHL7 FHIR
My ClaimsBenefitsPharmacyDeductible
Deductible Met62%
Open Claims2
Care Gaps1
Claim CLM-4421Paid, $2,480.00
PaidClaim CLM-4419Coordination of benefits review
ReviewWellness VisitCovered at 100%, no copay
EligibleAIAI PASS answered 91% of member questions this month directly from each member's own plan and claims record.
Workspace Overview
What Is HealthOS Member?
HealthOS Member is the workspace where members check Benefits, claims, pharmacy, coverage, deductibles and care, in language they actually understand. It draws from the exact same record as HealthOS CAPS, so the answer a member gets matches what actually happened, not a status code they have to decode.
Same Record as CAPS
Claim status and accumulator balances reflect what's actually been adjudicated, in real time.
Connects to NOVA When Needed
Questions that need a real conversation hand off to NOVA, HealthAxis's omnichannel contact center, with context attached.
Platform Foundation
Self-Service That's Only as Good as the Data Behind It.
Most member portals answer from a copy of the data that's already out of date. HealthOS Member runs on the same secure, shared core as every HealthOS workspace, so what a member sees matches what's actually true right now.
Immutable Security & Audit
Every member interaction is logged, supporting HITRUST and SOC 2 Type II obligations by default.
Shared Data Core
Claims, benefits, and accumulator data reflect the same live record used across HealthOS.
AI PASS Embedded Intelligence
Plain-language explanations and proactive care gap nudges are generated from each member's actual record.
Inside Member
Five Modules. Everything a Member Needs to Self-Serve.
Pick a module to see what a member actually sees inside it.
Benefits & Coverage
Members ask what's covered in their own words and get an answer based on their actual plan documents and benefit configuration.
Plan-Specific ExplanationsCoverage LookupPA StatusMulti-Language
Questions Answered MTD18,240
Self-Resolved91%
Escalated to NOVA9%
“Is this MRI covered?”Answered from plan benefit config
Resolved“Why was this denied?”Explained with adjudication reason
Resolved“Can I get a second opinion?”Escalated to NOVA
EscalatedHow Work Moves
From a Member's Question to an Answer They Trust.
Most questions never need a phone call.
A member logs in and asks a question in their own words, like why a claim was denied.
The question is matched to the member's actual plan, claims, and benefit data.
Most questions resolve immediately. Anything that needs a real conversation hands off to NOVA with full context attached.
The member gets a clear answer, and the interaction updates the same record CAPS and Plan already use.
The Intelligence Layer, Inside Member
Personalized Answers, Grounded in Each Member's Actual Record.
AI PASS translates coverage and claims data out of policy language, and proactively surfaces the care gaps and benefits most relevant to each member, without guessing.
Learn more about AI PASSLive decision intelligence● Active
“Why was my claim denied?”Explained01 / Review
Analysis completeClaim CLM-4402 matched to member record · Denial reason: service requires prior authorization on this plan variant · Appeal window open for 41 days.
RecommendationExplain in plain language and offer to start the appeal in-flow.
Confidence 95%
Why HealthOS Member?
The Numbers Behind the Console.
What health plans typically see after moving self-service onto Member.
30%Operating Margin Growth
25%Lower Case Worker Load
60%Faster Eligibility Processing
100%Audit Readiness
Why Member
What Changes When Self-Service Runs on Member.
The difference shows up in how many calls never have to happen.
The Old Way
- Members call customer service to ask why a claim was denied, because the portal can't explain it.
- Deductible balances lag behind actual claims by a day or more.
- Care gap reminders are generic and unrelated to the member's actual plan or history.
- Escalating to a live agent means repeating the whole story from scratch.
On Member
- AI PASS explains denials and coverage in plain language, grounded in the actual adjudication record.
- Deductible and accumulator balances update the moment a claim adjudicates in CAPS.
- Care gap nudges are personalized to the member's actual plan and quality measures.
- Escalation to NOVA carries the full context, so nobody repeats themselves.
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 HealthOS Member a chatbot?
No. HealthOS Member is a self-service workspace grounded in each member's actual plan, claims, and benefit data. When a question needs a real conversation, it hands off to NOVA, HealthAxis's omnichannel contact center, with context already attached.
How current is the claims and deductible information members see?
It reflects the same live record CAPS adjudicates against. Claim status, deductible, and accumulator balances update the moment a claim adjudicates rather than on a nightly batch, so a member sees what a customer service representative would see.
Does HealthOS Member support multiple languages?
Yes. AI PASS interprets member questions and generates plain-language explanations across supported languages, so members can ask about coverage and claims in the language they are most comfortable using.
Is HealthOS Member secure and compliant?
Yes. Member aligns with HIPAA, HITRUST, SOC 2 Type II, and CMS requirements, with role-based access control and a complete audit log of every member interaction.
One Console, One Suite
Six Workspaces. One Record.
Every HealthOS workspace reads and writes to the same core. Start with Member, connect the rest whenever your team is ready.
Get Started
See HealthOS Member 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.
