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Health & Human Services (HHS)
State HHS agencies, Medicaid programs, exchanges, managed-care organizations and providers, where HIPAA, uptime and the member experience all matter at once.
From statewide programs to the plans that serve them
NexSolv grew up inside state health and human services: Maryland’s MDTHINK eligibility and case-management platform, the Maryland Health Benefit Exchange, and Medicaid and public-health programs in several states. That same team now serves health plans and healthcare organizations among our 70+ commercial clients. The disciplines carry over: PHI-safe architecture, X12 and FHIR interoperability, and automation that takes days out of claims, appeals, prior authorization and member service.
Solutions for HHS agencies and health organizations
Claims & payment integrity
AI-assisted adjudication with readable edit explanations, pricing panels, 835 remittance views and ML-driven fraud, waste and abuse detection.
Utilization management
Prior-authorization agents that score requests against clinical criteria and route by confidence, with full audit trails.
Member & provider experience
Multilingual chatbots with secure human handoff, provider onboarding and data-quality automation, appeals and grievances triage.
Interoperability & data
HL7 FHIR, X12 270/271, 276/277, 835/837, NCPDP, data lakes, MCO performance analytics and regulatory reporting.
Security & compliance
HIPAA Security Rule, HITRUST-aligned controls, SOC 2 mapping, Zero Trust and DevSecOps for cloud workloads.
Behavioral health
Communications mining that detects reportable events in notes and incident reports and drafts the regulatory packet.