TIC URL Automation
(Marketplace) Issuers applying for QHP (Qualified Health Plan) certification, including issuers offering off-Exchange SADPs (stand alone dental plans), must submit a Transparency…
Rx Data Integrity Review
The current process for conducting the Rx Data Integrity review is time intensive and requires reviewers to manually review online formularies in a condensed timeline. The purpos…
RA and RADV Predictive Modeling and Methodology Evaluation
(Marketplace) Risk adjustment data validation (RADV) is the audit of HHS-operated Risk Adjustment (RA). KPMG, the main RADV contractor, seeks to conduct predictive modeling and…
RADV Medical Record Review
(Marketplace) RADV entails the review of enrollees' medical records to determine if diagnoses submitted to CCIIO for purposes of calculating RA transfers actually exist. This medi…
Issuer Expansion/Market Entry Prediction
CCIIO FO conducts targeted outreach to issuers likely to enter the markets or expand to other states
SBC Content Review
(Marketplace) The SBC Content Review identifies cost-sharing discrepancies between the Plans and Benefits Template and SBC Form. If there are discrepancies in the numerical values…
MFT UI Chatbot
Hub/MFT team manually supports operations related to onboarding, Q/A, file tracking and technical inquiries. ? Monthly Average of inquiries: ? ~800 Email inquires ? ~40 Jira/SN…
MLMS Upgrade MILA from CARLA to Druid
New chatbot proposed by CMS MLMS team will be integrated into the existing MLMS application. It aims to improve user experience, designed to maintain or boost deflection rates, an…
Interoperability URL Review Automation
Enable the team to save time and man hours, cost savings
C3PO: CMS Comprehensive Cybersecurity and Privacy Optimization
Reduce the burden of reviewing lengthy OMB, NIST and HHS policy documents, quicker review of SORN and PIAs
Integrated Data Repository (IDR) Customer Analytic Environment (CAE)
Provides an AI/ML environment connected to the IDR that enables CAE customers to focus on their AI use cases and business outcomes, without the burden of setting up or maintaining…
IDR Support Bot
The IDR Support Bot is an AI-powered chatbot that makes it easier for CMS users to get the IDR information they need, when they need it. It answers questions about IDR terminology…
Eligibility & Enrollment Medicare Online (ELMO) Chatbot
Assist Medicare caseworkers in navigating a fairly complex application
Production Operations Anomaly Analysis
Identify potential production issues proactively and refer for human analysis
Case Management Tool Case Creation & Automation
Automate and optimize manual case creation for incoming documents/requests and simplify manual tasks
AI to Improve Public Access to the Administrative Appeals Process
More effectively leverage online resources to better assist the public and reduce the number of misfiled appeals submitted to the Departmental Appeals Board (DAB) via electronic f…
AI Use Policy Tool
Ensure public confidence in the integrity of DAB decisions by maximizing quality review standards and reducing errors.
Resources to Assist the Advisory Board In Identifying AI Tools for Use In An Adjudication Environment
Agency adjudication activities require the analysis of large quantities of data to conduct docket analysis, identify efficiencies in case processing, and conduct 508 compliance re…
Renamed: 356H Machine Learning (ML) Facility Supply Chain Role Classification Previously: 356H ML Facility Supply Chain Role Classification
Manual classification of facility supply chain roles from FDA industry submissions (356h forms) is time-consuming and inefficient
Renamed: Risk-based FAR Review & Decision Support Previously: Field Alert Reports (FAR) Prioritization Model
Manual and subjective assessment process for Field Alert Reports (FARs) can lead to inconsistency in prioritizing and assessing reports, potentially leading to ineffective resourc…
Analytics-Driven Supplement Evaluation (ASE)
Exponential increase in post-approval chemistry, manufacturing, and controls (CMC) change submissions, with 80% being Changes Being Effected (CBE-30/0) notifications that may be s…
Renamed: FAR-based Facility Signal Detection Tool Previously: Post-market Surveillance Reports Signal Detection and Cluster Analysis.
Need for proactive detection of quality signals in post-market surveillance reports using statistical process control and topic modeling to identify potential drug quality hazards…
MedWatch Dashboard
Need to proactively identify emerging issues and clusters within MedWatch reports using advanced analytics.
Quality Surveillance Dashboard (QSD)
Need for consistent, data-driven assessment of drug manufacturing facilities and proactive detection of potential quality signals that could indicate problems with drug safety or…