MEDICAID RECERTIFICATION SOLUTION
AI AGENT

Proactive Risk Detection Agent

Our AI-powered monitoring system that identifies Medicaid beneficiaries at risk of procedural disenrollment 60+ days before coverage lapses, enabling early intervention.

93% Prevention Rate
60+ Days Early Warning
24/7 Monitoring

AGENT METRICS

15K+

Patients Monitored Daily

$9.2M

Average Revenue Saved

4.5 min

Alert Response Time

Core Responsibilities

Continuous Monitoring

Tracks renewal dates, document requirements, and eligibility status changes in real-time across your entire Medicaid population.

Pattern Recognition

Uses machine learning to identify early warning signs like missed appointments, returned mail, or demographic changes.

Alert Generation

Creates prioritized alerts for at-risk patients, triggering coordinated action from other agents in the system.

How It Works

Data Integration

Connects to your EHR, state Medicaid systems, and administrative databases to gather comprehensive patient data.

Risk Scoring

Analyzes 50+ risk factors including renewal dates, contact info accuracy, language barriers, and historical patterns.

Threshold Detection

When risk score exceeds threshold or critical dates approach, generates alerts with recommended intervention strategies.

Orchestration Trigger

Automatically triggers other agents (Outreach, Application, etc.) to begin intervention based on patient needs.

Communication Channels

API Webhooks

Real-time alerts to your systems

Dashboard Notifications

Visual alerts in care management portal

Secure Messaging

HIPAA-compliant team notifications

System Integrations

EHR Systems

Epic
Cerner
Athenahealth

State Systems

Medicaid MIS
EVV Systems
MMIS

Analytics Platforms

Tableau
Power BI
Looker

Dashboard Overview

At-Risk Patients

247 Critical

Sorted by risk score and days until coverage lapse

Risk Categories

Renewal Deadline

142

Missing Documents

89

Contact Issues

76

Recent Alerts

HIGH

Maria Rodriguez - 14 days until renewal deadline

MEDIUM

John Smith - Income verification needed

LOW

Sarah Johnson - Address update required

AI-Powered Medicaid Enrollment & Healthcare Access | HeyMedicaid