# Case Health AI

> Automating health plan operations with integrated AI agents.

Case Health AI helps health plans automate utilization management, prior authorization, care management, and member experience workflows using AI agents that work inside existing payer systems. The platform is built for enterprise healthcare organizations and integrates with existing payer systems rather than replacing them.

## Company

- **Category:** AI automation platform for health plan operations
- **Target customers:** Health plans, Medicare Advantage plans, Medicaid plans, commercial payers, UM vendors, and healthcare technology platforms
- **Compliance:** HIPAA compliant, SOC 2 compliant
- **Architecture:** FHIR-native, integration-first
- **Key outcomes:** 70% of approvals automated, 50% reduction in daily prior authorization volume, 3x ROI

## Products

### Utilization Management & Prior Authorizations

Automates prior authorization workflows from intake to determination support. Capabilities include intake automation, medical necessity review, determination support, and audit trail generation. Keeps clinical teams in control through human-in-the-loop review workflows.

### Case & Care Management

Helps payer care teams manage cases with AI-powered coordination. Capabilities include case summaries, workflow assistance, documentation automation, and risk and escalation detection. Reduces administrative burden for care teams while surfacing next-best actions.

### Member Experience

Helps payer teams deliver faster, clearer support to members and providers. Capabilities include authorization status updates, guided member support, provider experience workflows, and communication automation. Reduces repetitive service volume while improving member and provider satisfaction.

### Case Health AI API

FHIR-native AI infrastructure for UM vendors and healthcare technology platforms. Provides usage-based access to intake, medical necessity review, clinical summarization, and determination support APIs. Allows vendors to build AI-powered UM workflows inside their own platforms.

## Platform Principles

- **Integration-first:** Works with existing UM platforms, care management systems, CRMs, document repositories, data warehouses, and FHIR infrastructure. No rip-and-replace.
- **Human-in-the-loop:** Supports automation while keeping humans in control. All AI outputs are designed for human review with configurable thresholds and escalation workflows.
- **Healthcare-native:** Built specifically for payer operations including prior authorization, utilization management, case and care management, and member experience.
- **Enterprise security:** Role-based access control, secure integrations, audit-ready workflows, SOC2 Type 2, HITRUST, and enterprise-grade security controls.

## Contact

- **Website:** https://www.casehealth.ai
- **Demo:** Request a demo at https://www.casehealth.ai