1. Medicaid Eligibility and Enrollment Agent o Description: AI agent automates Medicaid eligibility determination and enrollment, verifying income, household data, and ACA criteria (e.g., 138% FPL in Maryland). Integrates with Maryland and Federal systems as nee o Demo Video Requirements: Show agent processing mock application, verifying data, determining eligibility, and enrolling applicant in HealthChoice MCO. o Technical Details: On-premises; integrates with MMIS, Health Connection; HIPAA-compliant. 2. Medicaid Ex-Parte Renewal Agent o Description: AI agent automates ex-parte renewals by cross-referencing enrollee data with state/federal sources (e.g., SNAP, tax records) to confirm ongoing eligibility without manual input, per CMS guidelines. o Demo Video Requirements: Show agent pulling mock enrollee data, verifying eligibility via external sources, and completing renewal. o Technical Details: On-premises; integrates with MMIS, federal hubs; HIPAA/FISMAcompliant. 3. Medicaid Redetermination Agent o Description: AI agent manages redeterminations for enrollees not eligible for ex-parte, sending notices, collecting responses, and updating eligibility status. Flags cases for human review if discrepancies arise. o Demo Video Requirements: Show agent sending mock notice, processing response, updating eligibility, and flagging discrepancy. o Technical Details: On-premises; integrates with MMIS, CRM systems; HIPAA-compliant. 4. Medicaid Claims Processing Agent o Description: AI agent automates claims validation, adjudication, and payment, replacing COBOL-based MMIS functions. Detects errors, ensures compliance with CMS rules, and flags fraud. o Demo Video Requirements: Show agent validating mock claim, correcting errors, adjudicating, and issuing payment.
