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Processes

What will AGI do for Manage ancillary services?

The health plan receives an authorization request, claim, or network update related to non-medical ancillary benefits such as dental, vision, or pharmacy.

Trigger
The health plan receives an authorization request, claim, or network update related to non-medical ancillary benefits such as dental, vision, or pharmacy.
Outcome
Ancillary service claims are adjudicated, members receive eligible benefits, and specialty provider network performance is monitored against plan targets.

The work itself

Grounded Work Profile

Measured by

  • Ancillary Claim Auto-Adjudication RateprocessProfile
  • Ancillary Medical Loss RatioprocessProfile
  • Ancillary Provider Network AdequacyprocessProfile
  • Ancillary Service Utilization RateprocessProfile

Key steps

  • Establish coverage limits and guidelines for non-medical ancillary productsprocessProfile
  • Contract with specialty providers or third-party administrators to deliver ancillary servicesprocessProfile
  • Process member eligibility verification for specific ancillary benefit tiersprocessProfile
  • Adjudicate claims and pre-authorization requests for dental, vision, or pharmacy servicesprocessProfile
  • Monitor service utilization and provider compliance against contracted service level agreementsprocessProfile

How AGI delivers it

Four ways AGI delivers for Manage ancillary services

  • Services-as-Software

    Get the professional outcome delivered as software, priced on results, not headcount.

    Services.do

  • Autonomous Agents as digital employees

    Hire a digital employee that does the job under earned, supervised autonomy.

    Agents.do

  • Business-as-Code

    Encode how your work runs, once, as software that executes itself.

    Platform.do

Value flow

How Manage ancillary services connects

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