Every intelligent enterprise is built on four layers.
HealthAxis unifies them for healthcare.
Health plans have automated claims, enrollment, billing, care, and more — yet functions remain siloed. AI PASS connects the enterprise, bringing intelligence, context, and action together across the health plan.
ENTERPRISE HEALTHCARE
Foundation. Operations. Intelligence. Experience. Four distinct layers. One connected way of working. AI PASS carries intelligence across the enterprise, turning information and capabilities into a health plan that can understand, decide, and act as one.
A unified data foundation beneath the enterprise. Member, provider, claims, and care data come together so every workspace works from the same information — creating the continuity needed for connected decisions and intelligent operations.
Choose the workspace that addresses your most expensive challenge and deploy it alongside your existing environment, with the underlying architecture remaining intact.
Whatever you start with reads and writes the same record. The second one you add is a configuration job, not another integration.
FHIR R4 and R5, HL7, X12 EDI, SMART on FHIR, Da Vinci and event APIs ship with the platform. Nothing to build in the middle.
SaaS, private cloud, your own cloud, hybrid or on-premise. Your compliance posture picks the model; the platform does not change underneath it.
AI PASS is the intelligence engine at the heart of the Enterprise Healthcare Operating System. It continuously observes, understands, predicts, and recommends across the enterprise — turning real-time context into action through CAPS, then learning from the outcome. Decisions happen in milliseconds, across petabytes of healthcare data, with a reason behind every one.
Six data domains — member data, provider data, claims and encounters, pharmacy data, financial and operational, and external and social drivers — feed the AI PASS engine, which returns better member experience, better care outcomes, higher operational efficiency, lower cost to administer, and stronger compliance and trust.
Most AI arrives as an attachment. AI PASS arrives as the architecture. The intelligence core sits at second layer, reasoning across every signal in the system. At the third layer, reasoning lands: HealthOS as the health-plan application suite, CAPS as the transaction core turning decisions into secure, auditable action. Four layers, one surface — the dashboard, in front of whoever needs it.
One ecosystem. Infinite possibilities. Better care for all.
From data to decisions, continuously — governed, explainable and safe. A closed reasoning loop that never stops learning, running across every layer above and below.
Where intelligent decisions become secure, compliant action. HealthOS is the application suite the plan works in; CAPS is the transaction backbone the whole enterprise runs on, built on the AxisCore administrative engine.
Unified data fabric, FHIR and X12 interoperability, zero-trust security and five deployment models.
The full health-plan application suite over a transaction core that adjudicates, pays and reconciles at scale.
30+ purpose-built agents, predictive and generative models, the knowledge graph and the governance around them.
Member, provider, employer and partner journeys, omnichannel service and the Executive Copilot.
Adopt the whole enterprise or start with a single layer. Because every layer shares one data model and one governance model, what you add later shows up in the same views your teams already use.
Intelligence turns data into action. Trust makes it usable at scale.
Healthier members. Better quality.
Transparent. Reliable. Secure.
Members stay. Providers engage. Employers renew.
Lower medical loss. Higher efficiency. Profitable growth.
Personalized, effortless, and equitable experiences.
Simplified workflows, faster decisions.
Lower costs, better outcomes, healthier populations.
Operational excellence, sustainable growth.
“The flywheel never stops. It gets smarter, faster, and more valuable over time.
This is what the four layers look like in practice. AI PASS turns connected data into real-time intelligence and action for every role — while each experience is powered by the operations and foundation beneath it.
Real-time intelligence. Unified visibility. Confident decisions.
Members
18.7M
▲ 3.2% vs PY
Medical Loss Ratio
84.6%
▼ 2.4 pts vs PY
Total Spend
$4.28B
▲ 1.8% vs PY
Quality (HEDIS)
4.2
▲ 0.3 pts vs PY
Member NPS
72
▲ 6 pts vs PY
Care Gaps Closed
312K
▲ 18.4% vs PY
Member growth trend
Total members
Spend breakdown
By LOB
Quality over time
HEDIS score
Top risks & alerts
EDI 837 batch latency — 2.3s above SLA
HIGHDuplicate claim cluster detected (47 claims)
MEDIUMNightly reconciliation complete — 0 exceptions
LOWProvider roster mismatch — Bayshore Health Group
MEDIUMAI insights
Premium PMPM trend on trajectory with expected growth.
ViewMembers at risk of readmission: 1,842
ViewOpportunity: close 8 care gaps this quarter.
ViewCoding identified 6 care gap candidates.
ViewRecent decisions & actions
Approved auto-adjudication rules
May 20Launched diabetes care campaign
May 18Increased behavioral health access
May 15Implemented prior auth automation
May 12Complete Visibility. Better Outcomes.
Enterprise visibility
360° Member View
Complete member health
360° Provider View
Provider performance
Care Intelligence
Population health
Financial Intelligence
Real-time financials
Quality Intelligence
HEDIS & quality
Operational Intelligence
Workflow performance
Illustrative product views. Figures are representative of a mid-size plan and are configured per client.
The numbers below are representative ranges, not projections. Where you land depends on your starting point. We establish your baseline first, then model the opportunity from there.
Automation takes out the rework, the manual touches and the reconciliation nobody ever budgeted for.
Straight-through processing validates and prices in a single pass; exceptions route to a person instead of into a queue.
The same team handles more work, with fewer errors turning up downstream three weeks later.
Every automated decision logged in a complete, audit-ready trail — not reconstructed after a finding.
Clean claims clear without a human touch, so people spend their day on the genuine exceptions.
For TPAs and risk-bearing entities managing delegated risk without the staff of a full health plan.
Each workspace is purpose-built for a dedicated healthcare function — all connected through the same data foundation and intelligence layer. Start with the problem that matters most today and expand when you’re ready — without creating another silo.
The administrative backbone. Claims administration, member eligibility, authorizations, benefits and care coordination in one connected workspace.
Explore HealthOS CAPS →HealthOS PlanPurpose-built for Medicare and government programs — enrollment, claims, prior authorizations, risk adjustment and contract performance.
Explore HealthOS Plan →HealthOS ProviderConnected provider operations: onboarding, credentialing, eligibility verification, referrals and reimbursement in one experience.
Explore HealthOS Provider →HealthOS MemberModern member experiences. Benefits, claims, pharmacy + coverage, deductions and care through intuitive self-service.
Explore HealthOS Member →HealthOS EnrollmentIntelligent enrollment and eligibility — guiding members from identity verification through enrollment and activation.
Explore HealthOS Enrollment →HealthOS SentinelProtect every payment. Identify fraud, waste, abuse, billing errors and payment anomalies before payments are made.
Explore HealthOS Sentinel →Health plans, TPAs, provider organizations, employers, PBMs and government programs all run on the same platform — each with the workspace, data access and controls their model demands.
Medicare Advantage, Medicaid managed care and commercial lines, all on one system.
Multi-client administration handled through configuration instead of custom code.
Value-based care enablement, and revenue integrity that holds up.
Transparent benefits management, and cost control you can actually act on.
Formulary, authorization and Rx claims sharing the same data model.
Modernization with compliance and reporting built in from the start.
Drawn from running healthcare administration at production scale — architecture, interoperability, AI governance, and operating benchmarks, kept current as the standards and regulation around them change.
See AI PASS on your own data. In a 30-minute walkthrough, explore the four layers, the experiences they power, and the numbers behind the opportunity.
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NewsHealthAxis’ SVP of Product Management, Norah Brennan, Authored Article Featured in The AI Journal
InfographicsLearn how STP works and how AI-powered claims platforms automate processing while intelligently managing exceptions.
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