AI Agent Studio
AI agents handle the caseload. Your team handles the judgment calls.
Intake classification, notice tracking, and audit prep consume the hours your team needs for higher-value work. Deploy pre-built agents for those workflows today, or build custom agents using AI Agent Studio for other workflows.
Studio
Autonomy
The Problem
Your team spends most of their time on work that follows rules.
Intake classification, notice tracking, and audit universe prep. These tasks are high-volume, rules-heavy, and repetitive. They consume staff hours that should go toward case resolution and audit remediation.
AI agents work like trained staff members who follow your compliance protocols, flag exceptions for human review, and log every action for audit.
of staff time*
Spent on manual intake
Appeals arrive via portals, faxes, mail, and phone. Data entry and classification scale linearly with case volume.
to respond
Regulatory notices pile up
HPMS notices, P&P updates, and contract amendments arrive faster than teams can interpret and assign them.
weeks per audit
Audit prep is still manual
Universe preparation for CMS program audits repeats the same manual effort every cycle.
ticket required
Every change goes through IT
Workflow adjustments, new case types, and CMS rule changes all require tickets. Operations waits days for minute-long changes.
Two Ways to Start
Deploy a proven agent today or build one from scratch.
Start with pre-built agents that handle common health plan operations. Or define custom agents for workflows specific to your organization. Either path gets you to a working pilot in weeks.
Deploy Pre-Built Agents
- Intake agents for appeals, grievances, and provider disputes
- HPMS notice and policy management agents
- Program audit and mock audit agents
- Configurable to your plan's compliance rules
- Live in as few as 4 weeks
Build Custom Agents
- Low-code agent builder with governed workflows
- Connect to claims, UM, member, and compliance systems
- Define escalation rules and human review triggers
- Same governance framework as pre-built agents
- Pilot deployment in six to eight weeks
Pre-Built Agent Catalog
Agents ready to deploy for your highest-volume operations.
Intake Automation Agents
Automate the classification, routing, and initial processing of incoming appeals, grievances, provider disputes, and other case types. These agents eliminate manual data entry at the point of intake and reduce classification errors.
Appeals Intake Agent
Classifies appeal type (clinical vs. administrative), extracts member and claim data, applies CMS timeliness rules, and routes to the correct review queue.
Grievance Intake Agent
Captures grievance details from portals, calls, faxes, and mail. Auto-categorizes by type and severity. Starts SLA countdown and assigns to appropriate staff.
Provider Dispute Intake Agent
Processes provider dispute submissions, validates required documentation, links to associated claims, and routes to dispute resolution workflows.
Custom Intake Agent
Configurable agent for any intake workflow: prior authorization, member complaints, quality referrals, or plan-specific case types.
Regulatory Notice Management Agents
Track, interpret, and operationalize regulatory notices across HPMS, policies and procedures, and government contracts. These agents work within Inovaare’s compliance management framework to close the gap between notice publication and internal action.
HPMS Notice Management Agent
Monitors HPMS for new notices, extracts key requirements and deadlines, and creates action items with assigned owners and due dates.
Policies & Procedures Agent
Identifies which internal P&P documents are affected by new regulatory guidance, flags sections requiring updates, and tracks revision workflows through approval.
Government Contract Management Agent
Tracks contract requirements, amendment deadlines, and reporting obligations. Alerts responsible parties before due dates and logs completion evidence.
Audit Management Agents
Prepare for and execute program audits and mock audits with agents that handle universe preparation, evidence gathering, and report drafting. Reduce the manual burden of audit season.
Program Audit Agent
Automates universe preparation (ODAG, CDAG, SNP-MOC), gathers supporting evidence from source systems, and drafts initial audit response documentation.
Mock Audit Agent
Runs internal mock audits against CMS audit protocols, identifies potential findings before the real audit, and generates remediation action items with assigned owners.
How It Works
From selection to production in four steps.
Select or Define
Pick a pre-built agent or define a custom one. Specify the workflow and data sources so the agent matches your operations from day one.
Configure & Connect
Connect the agent to your existing systems: claims, UM, member portals, and compliance tools. Configure escalation rules and human review triggers.
Test & Validate
Run the agent against historical data and edge cases. Catch misclassifications and compliance gaps before they reach production.
Deploy & Monitor
Launch the agent in production with real-time monitoring. Track accuracy, throughput, and escalation rates. Adjust configurations without IT dependency.
Operational Impact
What changes when AI agents handle
the repetitive work..
Pilot results from health plans deploying AI agents through Inovaare.
Targeted reduction in manual intake processing
Based on pilot data from automated classification and routing
Pilot deployment timeline
Pre-built agents with minimal configuration
Target classification accuracy
Fewer misrouted cases, less rework for your team
IT dependency for workflow changes
Self-service agent configuration by operations staff
Before & After
The same work, before and after AI agents.
Shifts audit operations from a reactive, effort-intensive function to a proactive, continuously ready operation.
| Process | Without AI Agents | With AI Agent Studio |
|---|---|---|
| Intake classification | Manual review, 15–30 min per case | AI-classified in seconds, staff reviews exceptions |
| HPMS notice response | Days to interpret and assign action items | Requirements extracted and assigned within hours |
| Audit universe prep | 6–8 weeks of manual compilation | Under one week with automated generation |
| Workflow changes | IT ticket, days to weeks turnaround | Self-service by operations staff, same day |
| Governance & audit trail | Manual documentation, incomplete logs | Every action logged automatically, audit-ready |
Why Inovaare
Layers onto existing core systems via API,
minimal disruption to current workflows.
General-Purpose AI Platforms
- Require months of custom development to handle healthcare-specific workflows and CMS compliance rules
- No pre-built understanding of appeals, grievances, regulatory notices, or audit universes
- Governance and compliance guardrails must be built from scratch for every deployment
- IT-dependent configuration and maintenance for every workflow change
Inovaare AI Agent Studio
- Pre-built agents with CMS compliance logic, timeliness rules, and health plan workflows built in from day one
- Purpose-built for appeals, grievances, regulatory notices, audit management, and payer operations workflows
- Every agent includes human oversight, permission-based access, and action logging by default
- Self-service configuration by compliance and operations staff, no IT tickets for workflow adjustments
Built for Your Role
What AI Agent Studio means for your team.
Whether you own the compliance posture, the audit function, or the budget — Inovaare delivers the outcomes your role demands.
Scalable AI Infrastructure
Deploy AI agents that layer onto existing claims, UM, and reporting systems with minimal disruption. Governed workflows and API-based integration with no unsanctioned tools.
- Layers onto existing claims, UM, and reporting systems
- HIPAA compliant, HITRUST certified infrastructure
- Role-based access and full audit trail on every action
- Fewer IT tickets for operations workflow changes
Measurable Workload Reduction
Reduce manual intake processing, cut rework cycles tied to misrouted cases, and give your team time back for work that requires human judgment.
- Targeted 50%+ reduction in manual intake processing
- Fewer misrouted cases and rework cycles
- Self-service agent configuration without IT dependency
- Real-time dashboards for agent performance and throughput
Audit-Ready Governance
- Human-in-the-loop validation on clinical and regulatory decisions
- CMS timeliness rules enforced automatically
- Complete audit trail for every agent action
- Mock audit agents identify gaps before CMS does
Representative Outcomes
What health plan leaders report after deploying AI agents.
Quotes represent composite feedback from Inovaare customers. Individual results vary.
FAQs
Questions health plans ask before getting started.
AI Agent Studio is Inovaare’s platform for building and deploying AI agents that automate health plan operations. It includes pre-built agents for common use cases like intake automation, regulatory notice management, and audit management. Health plans can deploy these agents as-is or use the studio to build custom agents for any operations workflow. Each agent operates with human-in-the-loop validation, role-based access controls, and full audit trail logging.
Inovaare offers pre-built agents across three categories. Intake Automation agents handle appeals, grievances, provider disputes, and custom intake workflows. Regulatory Notice Management agents cover HPMS notice management, policies and procedures management, and government contract management. Audit Management agents support program audit preparation and mock audit execution. Each agent is configurable to your plan’s specific workflows and compliance requirements.
Yes. AI Agent Studio includes a low-code agent builder that lets your team define custom agents for any health plan operations use case. You specify the workflow, data sources, decision logic, and escalation rules. The studio handles orchestration, compliance guardrails, and monitoring. Custom agents follow the same governance framework as pre-built agents.
Most health plans deploy a pilot agent within four to six weeks. Pre-built agents require minimal configuration and can be live even faster. Custom agents typically require additional time for workflow definition and testing. Inovaare provides implementation support including agent configuration, integration setup, and user training.
Every agent operates within a governed framework. Human-in-the-loop validation ensures no autonomous decisions on clinical or regulatory matters. Role-based access controls limit who can configure and deploy agents. Every agent action is logged with a full audit trail. Compliance guardrails enforce CMS regulatory requirements automatically. The platform is HIPAA compliant and runs on HITRUST certified infrastructure.
Yes. AI agents connect to your existing claims systems, authorization platforms, member portals, document management systems, and compliance tools through standard APIs and connectors. The platform layers onto your current infrastructure with minimal disruption. No rip-and-replace.
See AI Agent Studio in action.
Schedule a 30-minute demo. We’ll walk through the pre-built agents, show the custom builder, and discuss which use case fits your pilot.
Health plans that deploy AI agents before their next CMS audit cycle gain an operational advantage that compounds with every case processed.
30-minute walkthrough of your specific use case. No commitment required. Inovaare provides hands-on implementation support.