Who we serve

Medicare Advantage & Special Needs Plans

Stars, compliance, and SNP mandates — automated.

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40–60% lower admin cost·ROI within 90 days·Live in weeks·FHIR-native

The most demanding line of business

Medicare Advantage is the most operationally demanding line of business in healthcare:

01Star Ratings set your revenue.
02CMS clocks govern every authorization, appeal, and grievance.
03Audit readiness is a daily condition, not an annual event.

For Special Needs Plans the bar rises further: Model of Care commitments turn HRA completion, Individualized Care Plans, and Interdisciplinary Care Team documentation into scored, audited obligations — while enrollment growth outpaces coordinator capacity.

What plans tell us

In Medicare Advantage, audit readiness isn’t an annual event. It’s a daily condition.

Built for exactly this environment

CareInsight’s unified platform — careassistant.ai runs Care Management, Utilization Management, Appeals & Grievance, and LetterIQ all on one system with all 12 agents working together. By adopting the health3d.ai platform you surface hidden potential in the member record. CareInsight brings workflow automation to MA plans, which carry the most regulatory exposure and burn the most staff time of any other plan.

Where it helps

The Outreach Agent closes HEDIS and adherence gaps in every member’s language while the Inbound Agent answers calls 24/7 with zero hold time. Conversational Analytics gives quality leaders live measure performance instead of a monthly dashboard.

Why plans choose CareInsight

MA plans run on thin margins under maximum scrutiny. CareInsight delivers 40–60% lower administrative cost, ROI within 90 days, and a single platform where a member’s care plan, authorizations, and appeals are one connected story. FHIR-native, zero rip-and-replace, live in weeks on QNXT, Facets, or TriZetto.

A single platform for Stars, SNP mandates, and CMS compliance — live in weeks, at 40–60% lower cost.