Governance for payers running AI on member decisions.
Bias monitoring for utilization management, automated CMS-0057-F turnaround tracking, HIPAA-aligned audit trails, and adverse-action notices that satisfy state notification requirements when AI denies care.
12 modules purpose-built for Health
Each sub-module addresses a specific obligation in this vertical that the platform's 12 core modules combine with to give you full coverage.
Prior Authorization AI
CMS-0057-F turnaround tracking, denial reason explainability, regulator-ready evidence.
Claims Processing AI
Adjudication AI governance, fraud indicator review, audit trail integration.
CMS FHIR R4 Interop
FHIR R4 AuditEvent export and Member API alignment for CMS Interoperability rule.
HIPAA Privacy & BAA
BAA tracking, breach notification workflow, member-data minimization.
HITRUST Control Mapping
Control assessment + evidence collection toward HITRUST CSF audit.
PHI Scanner
Automated PHI / PII detection in model inputs, outputs, and logs.
Risk Stratification
Patient risk scoring with social-determinants integration.
Claims Fraud Detection
Pattern AI for claims fraud and adverse-event correlation.
Adverse Action Notices
Auto-generated notices for utilization-management denials.
State AI Bill Tracking
Per-state insurance-specific AI rules (NY, CO, IL, CA, etc.).
NAIC Model Bulletin
AI governance per NAIC Model Bulletin on use of AI by insurers.
SDOH Bias Analyzer
Disparate-impact analysis on social-determinants-driven decisions.
Every vertical inherits all 12 core platform modules
Vertical-specific sub-modules sit on top of Pratvi AI's full platform — model inventory, audit trail, bias monitor, drift, security posture, explainability, and more all apply uniformly across every vertical.
See how Pratvi handles Health specifically
30-minute walkthrough. No commitment. Bring your specific regulatory exposure and we'll map it to platform capabilities live.
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