One call, end to end — on infrastructure you can audit.
- Caller800 number · web
- TelephonyCisco · Genesys · Amazon Connect
- Decides intentand nothing else
- Groundingplan documents, cited
- Members, addresses with history, dependentsread verbatim
- Claims, paymentsread verbatim
- Per-turn audit logwritten every turn
System of record, not a script
Your database — any Postgres-class store — holds members, addresses with history, dependents, claims, payments, and a per-turn audit log. Every account fact the agent speaks is read verbatim from the record — the model never improvises data.
Through your stack, not around it
The architecture connects to client-approved telephony and contact-center estates, including Cisco, Genesys, and Amazon Connect patterns. The intent plane classifies the request; verified, typed fulfillment runs within the agreed tenant and data boundary.
Compliance is the spine
Identity verification before any account fact. RAG-grounded plan documents so copay answers cite a source. Per-action audit trail shipped with the call — the same licensed/unlicensed separation discipline as the rest of HealthNext.
Which member calls it can finish.
Containment is measured on your own traffic during shadow, against your own baseline — a number you can defend in a board review because you watched it being produced. What we state up front is structural: the call types the agent finishes on its own, and the named condition that ends its turn.
- Eligibility and benefitsclaims.lookup
Read-only · answered verbatim from the system of record
A question the record does not answer
Yes - Claim statusclaims.lookup
Read-only · answered verbatim from the system of record
Any dispute about the outcome
Yes - Prior authorization statusclaims.lookup
Read-only · status as it stands, never a prediction
Anything touching the determination itself
Yes - ID card requestfulfillment
Scoped write · to the address already on file
A new address in the same call
Yes - Address changeaddress.update
Write behind a confirm-read-back gate · address history kept
The read-back is not confirmed
Yes - Identity cannot be establishedverify
Fail-closed · name and date of birth, exact match
Three attempts, then a person
No — by design - Plan changes and enrollment—
Licensed-agent resolution
Licensed action · a licensed agent takes the call
No — by design - Distress, complaint or appeal—
Immediate human-led path
Warm transfer with the transcript and the intent attached
No — by design
The rows that say no are the reason the rest are credible. A licensed action never leaves a licensed person, an unverified caller never reaches the record, and a member in distress reaches a human with the transcript already in front of them.
Get the full operating modelTalk to Eva. Verify a member. Watch the database answer.
The demo runs against the real backend: verify as a seeded member, ask about coverage, change an address — it persists. Synthetic data, real plumbing. Verify as Sam Steele (June 30th, 1971), Maria Alvarez (March 14th, 1985), or David Chen (November 2nd, 1978).
Choose a scenario. Talk to Eva.
Your choice opens the prepared synthetic member call directly and hands the microphone from Nova—or any agent test—to Eva. Your browser may ask for microphone permission once.
Synthetic member records · one active voice experience
Tip: open Nova from the header and ask her to run the demo — she’ll hand you over to Eva with a member identity ready.
Run it for your clients — each one isolated, each one auditable.
For service providers and TPAs operating member services on behalf of payer-scale clients. The reference architecture separates agents, fulfillment scopes, document stores, and audit evidence by tenant, with provisioning and access policy treated as controlled engineering artifacts.
Tenant isolation
Per-client agents, scoped fulfillment, separate RAG document stores. One client's change never touches another's.
Supervisor controls
Role-scoped monitoring, whisper, and takeover paths can be integrated with the contact-center estate, with transcripts and dispositions designed to write to the governed operating record.
Compliance evidence
HIPAA-aligned posture, BAA-ready engagements, per-turn audit logs, verification-before-facts enforced in the playbook — evidence packs per client, per period.