OMB Individually Reported
Complaint Analysis
Low riskExact public inventory row
Description
Conduct high volume case analysis to identify root causes/trends that can be validated by SMEs and act as a workforce multiplier.
Detailed example
Identify trends, applicable regulatory citations, sample for validation, and recommended next steps.
AI / analytics pattern
Natural Language Processing: AI that processes, interprets, and shares information in human language.
Automation level / stage
b) Pilot – The use case has been deployed in a limited test or pilot capacity.
Expected benefit
Reduce repeat issues delaying benefits or access to care, and improve health plan compliance with federal rules and regulations.
Controls / human review
ATO: Yes; PIA: Not published
Data needed
data extracts from HPMS/CTM, and manually validated results based on standard criteria