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A change in Enrollment is visible in CAPS and Member at the same moment, not the next processing cycle.
The HealthOS Platform
HealthOS: The Healthcare Operating System for Payers, Care Networks, and Plan Sponsors
One sign-in. Six connected workspaces. One system of record.
HealthOS is an AI-native healthcare payer platform for health plans, TPAs and risk-bearing providers. It unifies claims, plan operations, provider management, member experience, enrollment and payment integrity on a single data core. Every workspace reads and writes to the same live record, with Aipass™ embedded across all six.
HITRUST SOC 2 Type II CMS HL7 FHIR
Platform Overview
What Is HealthOS?
HealthOS is the operational backbone of the HealthAxis Enterprise Healthcare Operating System (EHOS)™. It brings claims, plan operations, provider management, member experience, enrollment and payment integrity together in six purpose-built workspaces (CAPS, Plan, Provider, Member, Enrollment and Sentinel). All six run on one shared data core, with Aipass™ embedded throughout. Sign in once and every workspace your role needs is there, all reading and writing to the same live record.
HealthOS CAPS is the core administrative processing system for claims and plan administration. It is the AI-native evolution of AxisCore™, HealthAxis's long-standing core administration engine.
Standards-Based
Native support for EDI 837, 835, 270, 271, and HL7 FHIR R4 keeps HealthOS talking to what you already run.
Modular, Not All-or-Nothing
Adopt one workspace or all six. Every module plugs into the others whenever you’re ready.
Platform Foundation
Six Decades of Payer Infrastructure, Rebuilt as an AI-Native Platform.
HealthOS CAPS carries forward AxisCore™, HealthAxis's foundational core administration engine. The same security posture now runs as the baseline for all six workspaces, with Aipass™ wired in from the start rather than bolted on.
Cloud-Native Architecture
Built on cloud-ready microservices for zero-downtime scaling across all six HealthOS workspaces.
Immutable Security
Enterprise-grade encryption and SOC 2 Type II compliance as the security baseline for the entire platform.
Aipass™ Embedded Intelligence
The same intelligence engine runs underneath all six workspaces from one shared knowledge graph.
Inside HealthOS
Six Workspaces. Every One Built for a Different Job.
Pick a workspace to see what it actually handles.
HealthOS CAPS
The administrative backbone for modern health plans. Claims, eligibility, authorizations, benefits, and care coordination in one workspace.
Claims AdjudicationEligibilityPrior AuthorizationCare Coordination
Claims MTD8,447
Clean Rate93.6%
In Review412
CLM-4421Auto-adjudicated
PaidCLM-4419Coordination of benefits
ReviewCLM-9920Duplicate billing detected
HoldHealthOS CAPS is claims management software that runs the full claim from intake to payment.
Explore HealthOS CAPSHealthOS Plan
Plan operations for Medicare and government programs. Risk adjustment and Star Ratings measures update automatically from the same data as claims and enrollment. Aipass™ helps close care gaps.
Risk AdjustmentStar RatingsMARx ReconciliationContract Performance
HCC Capture87.3%
Clean Claims94.2%
Open Gaps1,204
Member #55214HCC gap flagged
ReviewMARx Batch 0619Reconciled
CompleteColorectal ScreeningGap closure in progress
OpenHealthOS Plan includes risk adjustment software built on the same live record.
Explore HealthOS PlanHealthOS Provider
Provider network and operations. Keep provider data in one place so claims, authorizations and member directories use the same record.
CredentialingDirectoryReferral ManagementContracting
Quality Score88.4
Credentialed3,455
Pending PSV27
Dr. AlvarezCredentialing complete
ActiveDirectory ListingVerified
ActiveGroup NPI 10442License renewal due
ReviewHealthOS Provider covers provider data management for your network.
Explore HealthOS ProviderHealthOS Member
The member's view of the same record. Members see the same claim and benefit in their own workspace the same day, without waiting on a processing cycle.
Benefits ExplainerClaims LookupPharmacyDeductible Tracking
Deductible Met62%
Open Claims2
Care Gaps1
Claim CLM-4421Paid, $2,480.00
PaidWellness VisitCovered at 100%
EligibleDiabetic Eye ExamReminder sent
OpenHealthOS Member is a member engagement platform on the same data core.
Explore HealthOS MemberHealthOS Enrollment
AI-guided enrollment. A new member completes AI-guided enrollment, and identity and eligibility are verified in one flow. Coverage is visible in CAPS the moment it is active.
Identity VerificationEligibilityPlan Selection834 Transactions
Completion Rate91%
Avg Time8 min
Activated MTD312
Application #4402Identity verified
VerifiedApplication #4398At risk of drop-off
At RiskBatch 834-0619Generated
ProcessedHealthOS Enrollment is health plan enrollment software that hands clean data to claims.
Explore HealthOS EnrollmentHealthOS Sentinel
Payment integrity before the payment goes out. Aipass™ reviews every claim pre-payment, before a dollar goes out the door, and flags issues such as duplicate payments.
Pre-Payment ReviewSIU Case ManagementOutlier DetectionRecovery
Prevented YTD$6.8M
Detection Accuracy95%+
Open Cases14
CLM-9920Duplicate billing detected
HoldCLM-9901Unusual coding pattern
ReviewProvider PR-118Outlier flagged
FlaggedHealthOS Sentinel delivers payment integrity across the claim lifecycle.
Explore HealthOS SentinelHow Work Moves
One Claim's Path Across the Platform.
What happens behind a single member interaction when every workspace shares the same record.
1. Enrollment
A new member completes AI-guided enrollment. Identity and eligibility are verified in one flow.
2. CAPS
The moment coverage is active, CAPS already has it. Claims can be adjudicated from day one.
3. Sentinel
Aipass™ reviews every claim pre-payment, before a dollar goes out the door.
4. Plan
Risk adjustment and Star Ratings measures update automatically from the same data.
5. Member
The member sees the same claim and benefit in their own workspace, the same day.
The Intelligence Layer
Aipass™ Runs Underneath All Six Workspaces, Not Next to Them.
The same engine that adjudicates a claim in CAPS also flags a duplicate payment in Sentinel and closes a care gap in Plan, working from one consistent view of the member. Aipass™ observes, understands, predicts and recommends, scoped to what each workspace needs.
Explore Aipass™Why HealthOS?
The Numbers Behind the Platform
6 Connected workspaces
12 Platform modules
1 Data core, every workspace
30+ AI agents
250+ Automated workflows
One of the largest TPAs in the country streamlined operations with HealthAxis. Read the case study →
Why HealthOS
What Changes When Six Systems Become One.
Six point solutions
- Claims, enrollment, and provider data live in separate systems that don’t agree with each other.
- Every new workflow means a new vendor, a new login, a new implementation project.
- AI gets incorporated onto one system at a time, if it’s added at all.
- Compliance and audit trails have to be reconstructed across five different tools.
One HealthOS
- Every workspace reads and writes to the same live record. One version of the truth.
- Adding a workspace is a configuration, not a new implementation project.
- Aipass™ is embedded across all six workspaces from one shared knowledge graph.
- Every automated and manual action logs itself, in one audit trail.
Security & Compliance
Built to the Standards Your Compliance Team Already Holds You To.
HITRUST SOC 2 Type II NCQA HL7 FHIR R4 CMS Interoperability Rule EDI 837 / 835 / 270 / 271
Read what the CMS interoperability rule means for payers in our CMS-0057-F guide →
FAQ
Frequently Asked Questions.
Do we have to adopt all six HealthOS workspaces at once?
No. Every workspace stands on its own. Most organizations start with the workspace tied to their most pressing need, then add others as priorities allow, without rework later.
How does HealthOS connect to systems we already run?
HealthOS supports standard EDI transactions (837, 835, 270, 271) and HL7 FHIR R4, integrating with clearinghouses, provider systems, pharmacy benefits and existing data warehouses.
Is HealthOS CAPS a replacement for AxisCore™?
HealthOS CAPS is the evolution of AxisCore™. The core administrative logic your team trusts carries forward, delivered through a modern AI-native workspace. → See HealthOS CAPS
What does Aipass™ actually do underneath the workspaces?
Aipass™ is the operational intelligence engine embedded across HealthOS workspaces and EHOS architecture. It observes, understands, predicts, and recommends, scoped to what each workspace needs. → Learn more about Aipass™
What is a healthcare payer platform?
A healthcare payer platform is software that runs the core work of a health plan or TPA: claims, enrollment, provider and member data, and payment integrity. HealthOS brings these into six connected workspaces on one data core, so teams work from the same record instead of separate systems.
Does HealthOS include a healthcare data platform?
Yes. All six workspaces share one data core, so claims, enrollment, provider and member data sit in one live record. HealthOS also integrates with existing data warehouses.
Does HealthOS support FHIR APIs and the CMS Interoperability Rule?
HealthOS supports HL7 FHIR R4 and standard EDI transactions (837, 835, 270, 271), and the CMS Interoperability Rule is among the standards it is built to. For what the rule requires of payers, read our CMS-0057-F guide.
Get Started
See HealthOS in the context of your healthcare operations.
Bring your line of business and your hardest workflow. We'll show you how it runs on one intelligent platform.
