Health Plans

Point solutions cover the head. Agents run the tail.

Eligibility checks and claims payment earned their platforms years ago. The rest of payer operations — credentialing exceptions, parity analyses, directory cleanup, benefit configuration — still runs on spreadsheets and headcount because no vendor's roadmap reaches that far. actAVA gives your teams governed agents for every workflow in the tail, built in days and audited from the first action.

Half of health plans already run AI. The tail is still manual.

A payer runs thousands of distinct workflows, and vendors build for the few dozen with the biggest transaction volumes. Everything below that line stays with your staff: each remaining workflow is too small to justify a platform purchase and too steady to staff away, so the tail persists year after year while the RFPs go to the head.

What the tail is worth

$21B

Still recoverable through full automation of manual transactions.

50%+

Health plans already using AI tools in administrative workflows.

$150–300M

Administrative savings AI can unlock per $10B of payer revenue.

The 2025 CAQH Index counted $258 billion in administrative cost already avoided through automation, with $21 billion still on the table in the manual and partially manual work that remains. More than half of health plans run AI tools in administrative workflows, yet the savings sit untouched because they hide in hundreds of small workflows rather than one big one. McKinsey sizes the administrative prize at $150 to $300 million for every $10 billion of payer revenue, before any medical cost effect. Read the 2025 CAQH Index →

Workflow volume, illustrative

Point solutionsYour teams, by hand

Vendors build for the head of the curve. The tail is where your teams spend their weeks.

General-purpose models can't carry this work alone.

On χ-BENCH, frontier models fail 72% of complex U.S. healthcare workflows, and fewer than 8% of agents stay successful when a task repeats. What you build around the model decides whether an agent is deployable.

Read the χ-BENCH study

The actAVA platform

One platform runs the whole tail. Build the agent, govern it, and own the model underneath.

Build any workflow with KORA

When a workflow is too niche for any vendor's roadmap, your operations team builds the agent on actAVA KORA in days. Agents work across chat, voice, and background processes with HIPAA controls and audit logs on every action. Each one tests against your rubrics and χ-BENCH-grade simulations before it touches production, then improves from reviewed work.

Explore KORA

Govern every agent with CHRYSO

A hundred small agents create a hundred audit surfaces, and actAVA CHRYSO governs all of them from one place. It writes your AI policies, trains your teams on them, and tests every agent against NIST AI RMF, HIPAA, and CMS requirements. When a regulator asks how an agent made a decision, the evidence is already assembled.

Explore CHRYSO

Own the intelligence with CURA

Long-tail economics fail when every agent rents tokens from a frontier lab. CURA, actAVA's trillion-parameter healthcare model, comes tuned on payer rules and parity policy, runs in your own cloud environment at a fraction of frontier cost, and stays yours, under your control. Operate CURA, frontier models, or both without rewriting a workflow.

Explore CURA

The agent library · Payer operations

Our payer workflow agent library, yours to extend

Start from working agents instead of a blank page. The library spans network and credentialing, plan configuration, member operations, utilization management, regulatory compliance, and value-based contracting, and every agent ships with HIPAA controls, human approval gates, and full audit logging.

Compliance
HITL · Human in the loop

Network & CredentialingCompliance

Provider Credentialing Agent

Runs the complete NCQA credentialing workflow, from NPI validation through primary source verification and exclusion screening, and routes exceptions to your committee.

Network & CredentialingHITL

Payer Enrollment Agent

Moves credentialed providers into your networks through requirement mapping, application pre-fill, and contract analysis, with your team approving each enrollment.

Network & CredentialingCompliance

Network Adequacy & Optimization Agent

Validates provider directories and runs CMS Medicare Advantage network adequacy calculations before the regulator does.

Plan ConfigurationCompliance

Plan Configuration Agent

Converts benefit documents into system-ready rules and validates mental health parity requirements before a plan goes live.

Plan ConfigurationHITL

Claims Adjudication Rules Agent

Configures behavioral health claims edits, manages code mappings, and tests claim batches before any rule reaches production.

Member OperationsHITL

Member Onboarding Agent

Manages new enrollments through health risk assessment scoring and primary care assignment, so members land in care instead of a backlog.

Utilization ManagementHITL

Behavioral Health Prior Authorization Agent

Handles the full prior authorization lifecycle, from intake through clinical review and denial management, with a clinician on every determination.

Regulatory ComplianceCompliance

Continuous Compliance Monitoring Agent

Watches regulatory updates and runs mental health parity comparative analyses continuously instead of once a year.

Value-Based ContractsHITL

BH VBC Performance Agent

Designs behavioral health value-based contracts with quality metrics and provider scorecards your network team can defend.

Explore the full library

90-day value realization

Start quickly.

Plan your agent roadmap and digital workforce budget.

Build agents immediately with the actAVA team beside you.

Integrate your systems of record and launch from the prebuilt library.

Run safely.

Establish your AI policies, frameworks, and evaluation rubrics.

Evaluate agent performance, inspect behavior, and improve it.

Govern every agent and orchestrate them across your systems.

Grow intelligently.

Control model costs with real-time consumption monitoring.

Distribute agent resources as functions and demand shift.

Measure ROI for every agent on a configurable dashboard.

Next step

Payer agents you can govern, prove, and own.

Every agent tests before it deploys, every action lands in the audit log, and the intelligence stays in your cloud, under your control. Name the workflow your team still runs by hand and we'll show you the first agent working against it.