Use Case 1
Real-Time Regulatory Feed Monitoring
Trigger: Federal Register, eCFR, Regulations.gov, or LegiScan publishes new content
1.Ingest new regulatory items daily
2.Filter to items relevant to plan operations
3.Classify by impact (parity, telehealth, network adequacy, Part 2, etc.)
4.Cross-reference affected plans, states, and configurations
5.Generate impact assessment with implementation timeline
6.Route to compliance officer with recommended action
✓
Regulatory changes hit operations with weeks of lead time, not weeks after they take effect.
Use Case 2
MHPAEA NQTL Comparative Analysis
Trigger: Quarterly review or new NQTL introduction
1.Inventory all active NQTLs across BH and M/S
2.Compare as-written stringency BH vs. M/S in same classification
3.Compare in-operation application using utilization and PA data
4.Apply state law overlays (CA SB-855, NY Timothy's Law, IL HB-2595, OR HB-3046)
5.Flag failures and document with CFR and state citations
6.Generate remediation memos for legal review and configuration handoff
✓
Plans pass MHPAEA audits because parity is monitored continuously, not just at filing time.
Use Case 3
42 CFR Part 2 Consent Audit
Trigger: Real-time SUD record access events
1.Log every SUD-flagged record access
2.Match against consent records on file
3.Classify access purpose (treatment, payment, operations, redisclosure)
4.Flag access events without valid consent for purpose
5.Investigate and document per event
6.Route violations to compliance and legal
✓
Part 2 violations get caught in days instead of discovered in audit, with full event-level traceability.
Integrations
Federal Register / eCFR / Regulations.gov APIs
LegiScan State Legislative Tracking
MHPAEA NQTL Library
SUD Record Audit Logs (42 CFR Part 2)
CAPS Platforms (Facets, QNXT, HealthRules)
Approval Workflow (RequestApproval)
Industries
healthcare
See It In Action
A sample conversation with this agent
Anything new this week that affects our plans?
Three items worth reviewing. One, CMS published a 2026 Q2 PFS update adding three new BH HCPCS codes—impacts rate schedule for 14 plans, additive coverage so parity-low risk. Two, California released proposed regulations under SB 855 strengthening generally-accepted-standards-of-care language—comment period closes May 12, recommend submitting comment via legal. Three, Federal Register published the MHPAEA Final Rule technical correction clarifying NQTL comparative analysis documentation—we have 23 active NQTLs that need re-documented under the corrected language. Drafting impact assessments now.
Run the quarterly MHPAEA NQTL comparative analysis.
Pulling all active NQTLs across BH and medical/surgical: 47 NQTLs in scope (PA requirements, fail-first protocols, step therapy, medical necessity criteria, network composition, provider reimbursement methodologies). For each, comparing as-written and in-operation application across BH vs. M/S in same classification. Findings: 3 NQTLs fail comparative analysis—BH PA on outpatient psych testing without M/S equivalent, BH visit caps absent on M/S, and reimbursement methodology gap on BH telehealth. All three become parity remediation triggers feeding to the plan configuration agent. Legal-review-ready memo with CFR citations attached.
What's our 42 CFR Part 2 audit status?
Running real-time consent audits across SUD records. Last 30 days: 14,238 SUD-flagged records accessed, 14,201 with valid Part 2 consent on file, 37 access events without documented consent—each requires investigation. Of the 37: 23 were treating clinician access (likely permitted under treatment exception, documenting), 9 were billing/operations access requiring explicit re-disclosure consent (consent missing—remediation needed), 5 were data warehouse extracts I'm flagging as potential redisclosure violations. Routing the 14 problematic events to compliance and legal.