🎉 HealthEdge® and Case Health AI partners to bring AI to health plan operations 🥳View announcement
Case Health AI is the AI layer inside your platform. We build the integration, run the selling, onboard each plan, and keep engineering the models behind it — and we share revenue, so we only win when you do.
The product your plans already work in every day. Nothing about it changes — we connect through the APIs you already expose.
We build and run the AI agents behind every workflow your plans need — the models, the clinical reasoning, and the oversight around them.
They get production AI years ahead of what other vendors can offer them — without leaving your platform.
Case Health AI runs behind the platform you already have. We connect through the APIs you already expose, put our agents to work on the cases inside it, and write results back onto the same records — so everything surfaces in the screens your customers already use.
Our engineers build that connector, on our clock and at no upfront cost to you.
Our team does the outreach, runs the demos, answers the clinical and security questions, and handles issues after go-live. You never have to assemble an internal team around a product we built.
And the partnership runs on a revenue share rather than a license fee, so a plan going live pays both sides. Terms are set per partnership.
We prospect and open conversations alongside your team.
Demoed against the plan's own workflows and volume.
Our clinicians and solutions team answer them directly.
We configure the agents to the plan and train their team.
Tickets and edge cases come to us, not to your support desk.
REVENUE SHARING
Once a plan signs, our clinical and solutions team works directly with them: deciding which workflows go live first, loading their policies, setting thresholds, and tuning each agent to how that specific plan operates.
We meet the plan's operations leadership, scope which workflows go first, and take in the policies and lines of business behind them.
A named solutions lead and clinical lead stay assigned to the plan after go-live — not a handoff to a queue.
Every threshold is configurable. Plans decide how much each agent can act without a reviewer signing off.
We sequence the rollout with them — one workflow proven before the next one turns on.
Launching a plan is where our engineering starts, not where it stops. Language models, document vision, and agent orchestration stay under active development by our research team — and every improvement reaches your customers without a migration, an upgrade project, or a line of code on your side.
Language Models
Purpose-built for payer workflows — trained on clinical guidelines, policy criteria, and prior authorization patterns across lines of business.
Vision Models
Document vision that reads what payers actually receive — faxed clinical notes, handwritten orders, blurry scans — and extracts structured data from all of it.
Agents
Individual agents for intake, review, summarization, and determination — orchestrated into complete workflows that run from submission to decision-ready output.
We monitor every plan, resolve every edge case, and keep every model current. Common partner questions →
Continuous performance monitoring across all plans and workflows, with automated alerting on accuracy drops.
All support tiers are staffed by our team. Issues never route back to your support desk.
Clinical criteria and coverage policies are reviewed and updated every quarter — or sooner if a plan's guidelines change.
Every AI output is logged with source citations and reviewer actions, creating an audit-ready record for every case.
Common questions from UM vendors and healthcare technology platforms evaluating a Case Health AI partnership.
