A more proactive, more human approach to Medicaid renewal.
TVS brings member engagement, Agentic AI and human support into one coordinated workflow, helping health plans guide members from the first notice to a clear next step.
Renewal involves more than a form. Members must understand their notices, know what information is needed and reach the right support before deadlines pass. Health plans need a coordinated way to follow that journey.
A notice may not reach the member, or the required action may be unclear.
Changed contact details and missing documents can interrupt the process.
Members may need help finding the correct state, county or health-plan contact.
Start with the health plan’s population, outreach process and existing systems. Configure the applicable program rules, guide the conversation and keep human navigators involved when a question needs judgment or additional support.
The architecture separates member interaction from a reusable rules library and system integrations, allowing new programs and states to be configured as the service develops.
A conversational experience designed to help members understand renewal, identify what to do next and connect with human assistance when needed.
Clarify the member’s question, situation, state and program.
Reference configured rules and identify the appropriate next action. Eligibility decisions remain with the responsible agency.
Explain the next step, help organize required information and summarize outstanding tasks.
Route uncertainty, conflicting rules and unresolved needs to a human navigator.
When information is incomplete, a rule conflicts or the member needs additional assistance, the workflow pauses for human review. The prototype preserves the California conflict handoff rather than attempting to resolve an uncertain rule automatically.
A handoff includes the member’s question, information already collected and remaining actions, so the next person can continue with context.
Plan for web, voice, SMS and health-plan portal touchpoints around a shared member journey.
Define how case status, documents and navigator tasks connect with existing plan workflows.
Establish approved rules, privacy controls and integration requirements before production use.
Agree on a defined population, geography and operating workflow. Track member reach, engagement, next-step completion, human handoffs and unresolved cases. Where authorized data is available, assess renewal outcomes and operational effort.
These are pilot measures, not claims of achieved results. Expansion follows evidence and agreed go/no-go criteria.
The current experience demonstrates guided conversation and workflow design. Live member records, document submission, eligibility systems and production outreach require separate integration and approval. The prototype does not enroll members, submit renewals or make final eligibility determinations.
Let’s define a practical first use case for your health plan.
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I don't try to sell anything. I architect solutions that bring the best of breed together so organizations get it right the first time.