Overview
Healthcare has its own legacy baggage: eligibility checks buried in EDI, opaque prior authorization, scheduling friction, and pricing that feels like roulette. It’s time for a Modern Healthcare Retailing model — parallel to what airlines did with Modern Airline Retailing.
Our Offer Engine lets providers, payers, and platforms assemble healthcare “products” dynamically — whether that’s a bundled procedure, a telehealth package, or a coverage extension. Eligibility becomes programmable, pricing explainable, and capacity (beds, slots, staff) enforceable in real time.
High-impact use cases
Real-time eligibility
Replace batch EDI checks with instant, API-driven eligibility for patients and services.
Dynamic care bundles
Assemble procedure + follow-up + medication as one transparent offer.
Capacity throttling
Beds, OR slots, telehealth appointments — allocate dynamically, avoid overbooking.
Smart pricing
Blend cost benchmarks, negotiated rates, and ML forecasts — with compliance guardrails.
Prior auth automation
Dynamic validation rules can pre-clear or deflect prior authorizations instantly.
Explainable coverage
Show patients and providers why coverage was approved or denied — instantly, auditably.
How our modules fit
- Dynamic Validation — eligibility, benefit limits, medical necessity, compliance rules.
- Offer Engine — bundle services, visits, and coverage extensions into coherent patient offers.
- Dynamic Pricing — transparent pricing: DRGs, negotiated rates, ML cost forecasts, with guardrails.
- Stock (Capacity) Keeper — monitor and throttle scarce resources like staff slots, beds, devices.
- Order Store — maintain audit trails of eligibility checks, bookings, and billing events.
Reference architecture
Deploy per engine with clean APIs, HIPAA-ready observability, and zero-downtime versioning. Managed or self-hosted — you choose, we enforce compliance controls.
Key design choices
- Eligibility as code: replace static payer tables with rule files you can change daily.
- Composable offers: patient-centric bundles, not siloed line items.
- Capacity control: atomic counters for OR slots, ICU beds, and staff hours.
- Auditability: every eligibility check and booking logged, versioned, and explainable.
- Interoperability: FHIR, HL7, and OpenAPI adapters out of the box.
FAQs
Is this an EMR replacement?
No — we complement EMRs/PAS by externalizing eligibility, pricing, and capacity logic. Faster to change, easier to audit.
How does it handle compliance?
All modules support HIPAA/GDPR controls, encryption, and full audit trails. We provide evidence packs for regulators.
Can it integrate with payers?
Yes — APIs can front or wrap legacy payer systems. Eligibility/coverage rules can be layered in real time without changing the PAS.
What about performance?
Airline-grade latency: eligibility checks in <100ms; scalable to millions of daily calls.
Can we start small?
Absolutely. Pilot with one eligibility rule set or capacity counter, then expand across departments.