Share Your Vision for AI in Healthcare and Win a
Free Proof of Concept!


We’re calling all innovators to submit AI use case ideas for Payers. The top three ideas will win a complimentary Proof of Concept (POC).

AI has the potential to revolutionize payer operations, and we’re already exploring innovative use cases with Simplify Healthcare AI™ to Enhance Sales, Network Performance, and Service Operations. Check out the possibilities below, and if you have a unique idea, we’d love to hear it!

Win a free AI POC

Explore some of the ways Simplify Healthcare AI™ can transform healthcare operations

Adopt AI meaningfully and quickly for discrete business use cases, delivering high value and true business outcomes.

Plan Comparison

Plan Comparison

Enriches sales motions by extending side-by-side benefit analysis with fresh insights on benefits and costs, simplifying engagement for brokers making your organization a preferred choice.

Quickly match the best plans based on incumbent plan benefits

 

  • Automated SBC Intake Comparison
    Determine comparable plans based on past & competitive SBC documents
  • Benefit Match Score
    Compare multiple plans & their match score based on detailed benefits
  • Benefit Weights Configuration
    Understand which benefits provide better options than the previous year

Census Intake

Census Intake

Extracts and normalizes census data from non-standard Excel/CSV files, transforming it into industry-standard formats for seamless use in quoting and enrollment.

Intake any Census file format and normalize data process within seconds

 

  • AI Powered Census File Process
    Intake any Census file and normalize data to standard format
  • Pre-built Business Logic
    Integrated business logic to determine errors or incompleteness
  • Convert Census data into format
    Downloadable file formats for geoaccess eligibility and underwriting review

Plan Recommendation

Plan Recommendation

Tailors plan recommendations to prospect group needs and budgets using historical sales data, boosting conversion rates by presenting plans with higher appeal and alignment.

Advise groups on the best matched plans based on their needs & annual budget

 

  • EOC & SBC Intake Analysis
    Determine comparable plans based on group info, needs, & budget
  • Advanced Employee Preference Filters
    Tailor plans based on previous plan sales & filter by employee locations
  • Benefit Match Score with Annual Cost
    Review best matched plans & estimated costs within defined budget

Plan Summarizer

Plan Summarizer

Extracts key plan benefits and provisions from documents such as Summaries of Benefits, SBCs, Benefit Highlights, and Plan Grids. Presents essential insights in multiple formats for seamless use.

Quickly extract the plan benefits information from EOC or SBC Documents

 

  • SBC Upload & Extraction
    Supports the efficient upload of EOC or SBC PDFs from health plans
  • Multiple Data Format Support
    Supports export of HTML and On-Screen layout export
  • Easy Export
    Extract Plan benefit information can be easily copy-pasted into your Microsites

Plan Guides

Plan Guides

An interactive platform enabling brokers to explore and compare plan benefits and provisions intuitively. Simplifies sales workflows and equips brokers with powerful AI tools for competitive research.

Quickly access critical plan details and refine results with AI-driven accuracy

 

  • Device-Optimized Viewing
    Access plan guides on any device with responsive formatting for a seamless experience
  • Searchable and Filterable
    Use advanced filters to find information by field names or main headings, reducing search time
  • AI-Powered Search
    Quickly locate specific plan details using AI-enhanced search capabilities

Geo Access

Geo Access

Determine employee time and distance against your network to ensure minimum adequacy rules are met across various provider specialities.

Ensure adequacy by calculating employee distance to provider specialties

 

  • AI Driven Employee Intake
    Capture and standardize employee data for geo access evaluations
  • User Interface Dashboard
    Assess employee-to-provider adequacy and apply detailed filters
  • Secure and Compliant
    Secure and compliant integration with provider and member data

Renewal Insights

Renewal Insights

Reinvents the group renewal process by predicting churn, simulating attrit to competitive plans, and driving retention with actionable insights—turning potential attrition into growth opportunities.

Provide sales leaders insights on competitor plan benefits and rates

 

  • Compare Plans to Competitors
    Analyze quoted plans against competitors to identify gaps and close rate
  • Renewal Plan Suggestions
    Recommend renewal plans that outperform those of competitors based on our insights
  • Recommend Plans
    Recommend plans that offer more advantageous benefits than those provided by the competitors

Plan Benefit Designer

Plan Benefit Designer

Simulates the design of competitive ACA plans by analyzing the macro market landscape, including prevailing premium rates, benefit richness, and comparative plan scoring.

Drives sales by aligning benefits with prospect priorities

 

  • Automated RFP Analysis
    RFP summarization with key “asks” from the RFP and provide a “briefing” to the Sales team
  • Automated Ingest of Experience Data
    Gather artifacts shared in different formats with the discern vital information needed for Underwriting
  • Plan Design Recommendations
    Compare incumbent plan characteristics to previously ”sold plans” and offer plan design recommendations

Plan Insights (MA)

Plan Insights (MA)

Analyzes Medicare Advantage plan rates, star ratings, benefits, and enrollment data to evaluate competitive positioning & provides insights to optimize plan offerings.

  • Rate Distributions
    Easily glean how various plans have rate distributions across age groups, metal tiers and other dimensions
  • Plan Level Scoring
    Understand how your plans stack up against competitive plans with respect to the overall richness of the plan offering
  • Benefit Richness
    Gain new insights into benefit level strength versus competitive plans. Evaluate overall plan strength measured by over a dozen dimensions

Plan Insights (ACA)

Plan Insights (ACA)

Provides insights on ACA plans to benchmark against competitors and uncover market gaps. Enables data-driven adjustments to improve plan attractiveness and member acquisition.

  • Rate Distributions
    Easily glean how various plans have rate distributions across age groups, metal tiers and other dimensions
  • Plan Level Scoring
    Understand how your plans stack up against competitive plans with respect to the overall richness of the plan offering
  • Benefit Richness
    Gain new insights into benefit level strength versus competitive plans. Evaluate overall plan strength measured by over a dozen dimensions

Benefit Highlights

Benefit Highlights

Generates consumer-friendly benefit descriptions and enhances plan presentations to improve engagement and streamline decision-making, driving member acquisition and retention.

  • Improve Shopper Experience
    Leverage AI to ensure plan benefits are presented with clarity and relevance
  • Streamline Benefit Analysis
    Automate extraction of key benefit details from complex documents for faster decision-making
  • Enhance Plan Presentation
    Generate accurate, user-focused plan cards that highlight additional benefits effectively

EOC Summarization

EOC Summarization

Generates consumer-friendly benefit descriptions and enhances plan presentations to improve engagement and streamline decision-making, driving member acquisition and retention.

  • Layman-Friendly Explanations
    Present salient features in easy-to-understand terminology for better user comprehension
  • Simplify EOC Documents
    Extract and summarize key aspects of complex EOC documents into consumer-friendly language
  • Interactive User Experience
    Embed AI-powered summaries into the Medicare Advantage Shopping Portal for seamless navigation

Network Insights

Network Insights

Analyzes Machine Readable Price Transparency Files to evaluate provider network relative strength, detect adequacy gaps, and refine network strategies and delivers actionable competitive insights.

Identify network gaps, optimize network,& stay competitive in the market

 

  • Speciality Heat Map
    Visualize & Compare Network gaps by specialization & zip code
  • Competitor Network Comparison
    Compare aggregated networks & pricing against other plans
  • Adequacy by Location
    Determine adequacy requirements based on state & county enrollment

Network Adequacy

Network Adequacy

Evaluates compliance with regulatory standards for provider access across specialties and geographies. Ensures members have sufficient access while mitigating compliance risks.

Ensure compliance and enhance member access with AI-driven network insights

 

  • Provider Gap Heatmaps
    Visualize coverage gaps by specialization and geographic region to identify underserved areas
  • Regulatory Compliance Reporting
    Automate adequacy evaluations aligned with state and federal standards
  • Adequacy Analysis Dashboard
    Review time-distance measures and other compliance metrics through an interactive dashboard

Provider Recommendations

Provider Recommendations

Recommends provider recruitment by analyzing coverage levels and negotiated rates, enabling carriers to target cost-effective providers while strengthening member access to robust networks.

Ensure compliance and enhance member access with AI-driven network insights

 

  • Gap Analysis with MRF Data
    Analyze MRF files to identify areas with insufficient provider coverage based on geographic access
  • Dynamic Coverage Heatmaps
    Generate visual heatmaps highlighting underserved regions or specialties within the network
  • Provider Recruitment Suggestions
    Recommend specific providers or facilities to include in the network to close coverage gaps

Provider Roster Intake

Provider Roster Intake

Automates intake, validation, and standardization of provider data, detecting required actions from rosters to maintain accurate provider directories and related processes.

Streamline the intake and management of provider rosters with AI-driven automation

 

  • Automated Provider File Normalization
    Intake provider roster files in various formats and normalize data into a standardized structure
  • Dynamic Roster Validation
    Validate provider information such as NPI, specialties, affiliations, and locations against external databases
  • Seamless Integration
    Provide API support for real-time ingestion into existing network management platforms

Provider Contract Reconciliation

Provider Contract Reconciliation

Leverage AI to consolidate and reconcile legacy contracts and their multiple amendments, producing an accurate, updated contractual baseline that reflects all historical changes.

Quickly create a unified, searchable contract baseline with AI-driven precision

 

  • AI-Powered Reconciliation
    Automate the consolidation of legacy contracts and amendments for a unified baseline
  • Contract Anchor Identification
    Extract and identify key contractual anchors for understanding and decision-making
  • AI-Driven Digitization
    Convert physical and scanned contract documents into digital, searchable formats for ease of access

Enrollment Validation

Enrollment Validation

Validates enrollment documents for accuracy, ensures all required forms are received and complete, and accelerates group onboarding from days to minutes.

AI-Powered Enrollment Validation for Seamless Document Submission

 

  • Automated Document Review
    Review all enrollment documents, ensuring they meet complete and accurate submission standards
  • Real-Time Gap Notifications
    Provide instant alerts about any missing or incorrect information, enabling brokers to correct issues before submission