Ingest 835/837P EDI remits and EMR exports into a zero-PHI, trace-governed Google Cloud & Vertex AI pipeline. Recover underpayments, neutralize CARC 197/50 denials, and enforce Mental Health Parity across Detox, Residential, PHP, IOP, and OP levels of care.
Behavioral health and addiction treatment providers face systemic administrative friction from commercial payers. H3 automates parity defense, underpayment recovery, and operational compliance.
Commercial payers systematically cut coverage before patients are clinically stabilized. H3 grounds appeals in ASAM 6-dimension criteria and federal MHPAEA parity mandates to overturn arbitrary medical necessity denials.
Payers exploit retroactive authorization delays to freeze cash flow. H3 cross-references submission timestamps against emergency care statutes and admission records to enforce timely-filing and retro-auth rules.
Insurers regularly underpay fee schedules and withhold remittances past statutory limits. H3 runs pure Decimal math to enforce contractual allowances and calculate mandatory 15% p.a. statutory interest under CA Knox-Keene § 1371.35 & ERISA § 502.
Our 7-stage production architecture (`h3-healthcare-prod`, us-west2) combines fail-closed Zero-PHI data protection with bounded Gemini 2.5 reasoning and deterministic financial ledgers.
835/837P EDI drops, CSV remits, and Kipu/Navix EMR exports ingest directly into CMEK-encrypted Cloud Storage buckets (gs://h3-claim-raw-intake, gs://h3-vault-facility, gs://h3-vault-litigation) protected by Cloud KMS.
Google Cloud Sensitive Data Protection (Cloud DLP GATE-001) performs fail-closed Zero-PHI redaction before any processing. SHA-256 tenant/matter cryptographic isolation (GATE-002) strictly segregates client and matter data.
Zero LLM arithmetic authority. Proprietary Python reconcile.py enforces Underpayment = max(0.00, Allowed - Paid) and calculates statutory prompt-pay interest schedules (e.g. 15% p.a. under CA Knox-Keene § 1371.35 and ERISA § 502) with zero hallucination risk.
Pattern J3 dynamic routing dispatches simple administrative denials to Gemini 2.5 Flash and complex multi-issue clinical/parity disputes to Gemini 2.5 Pro via asynchronous Cloud Tasks (jev-shadow-queue).
Sandboxed Gemini execution at temperature=0.0 via the official google-genai SDK. Constrained strictly to Pydantic v2 structured JSON schemas and bound exclusively to verbatim extracted evidence IDs (EV-xxx).
Verification engine routes valid assertions into canonical_admission.py while isolating unverified or non-conforming citations into finding_quarantine.json, strictly preventing hallucinated citations and enforcing non-clinical / non-attorney UPL boundaries.
State persistence in Cloud Firestore (claim_runs), JEV shadow grounding telemetry streamed to BigQuery (h3_analytics.jev_shadow_evaluations), and tokenized payer denial patterns mapped in an isolated Neo4j Knowledge Graph (:H3:ClaimCase, :H3:Payer).
Tailored enterprise cloud environments supporting both direct clinical provider recovery and litigation law firm work-product protection.
Designed for Detox, Residential, PHP, IOP, and Outpatient facilities struggling with clinical step-down denials, CARC 197/50 disputes, and slow payer cash flow.
Engineered for complex commercial payer dispute litigation, ERISA § 502 class actions, and out-of-network provider underpayment suits.
Zero-Touch SaaS Deployment: From 835/837P Batch Ingestion to Autonomous Recovery in 48 Hours.
For organizations seeking immediate visibility into trapped revenue, underpaid fee schedules, and historic CARC 197/50 denial volume.
For high-throughput facilities actively processing daily claims that require real-time pre-submission scrubbing and automated denial defense.
For large multi-facility behavioral health operators and litigation law firms managing high-exposure ERISA and parity disputes.
Modular agentic systems designed to operate independently or as a unified intelligence layer.
Our autonomous forensic claim intelligence engine. Ingests 835/837P EDI data, extracts ASAM clinical criteria, enforces Mental Health Parity laws, and overturns medical necessity and pre-authorization denials.
View Cloud Architecture →Clinical front-door onboarding and automated Verification of Benefits (VOB/EOB). Eliminates front-end eligibility errors, collects structured intake documentation, and accelerates admissions.
Explore Intaker™ →Real-time outpatient and residential revenue telemetry. Auto-detects modifier conflicts (-59, -91, -76), monitors net days in A/R, and provides executive visibility across multi-site care teams.
View Dashboard Specs →Interactive self-service diagnostic engine that evaluates operational friction, denial risk exposure, payer concentration vulnerabilities, and prompt-pay lag in minutes.
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