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AI & Data Services
From readiness assessment to production agents: we build AI that regulators can audit, caseworkers can trust and your security team can approve.
AI you can put in front of an inspector general
Most AI pilots in government stall at the security review. NexSolv designs for that moment from day one: every agent we ship produces policy citations, source-and-timestamp data checks, a confidence band and an exportable PDF/JSON audit trail. Humans stay in the loop for every consequential decision, and PHI never leaves your environment.
We have already built and demonstrated eleven AI and RPA use cases for Medicaid and public-health operations in response to the Maryland Department of Health’s request for AI, LLM and RPA solutions. All run on synthetic or de-identified data and are built for low-friction pilots that scale.
How a NexSolv agent processes a case
Every NexSolv agent follows the same five stages, which is why each one ships with policy citations, a confidence band and an exportable audit trail.
What we deliver
AI readiness & strategy
Use-case discovery, data and infrastructure assessment, risk tiering and a 90-day roadmap your leadership can fund.
Responsible AI governance
Policies, model cards, bias and fairness checks, human-in-the-loop controls and NIST AI RMF alignment.
LLM & agent engineering
Domain-tuned LLMs, retrieval-augmented generation, policy-grounded copilots and agentic workflows for eligibility, claims, appeals, prior authorization and member services.
Evaluation & safety
Prompt and tooling governance, test harnesses, red-team scripts, PHI and PII screens, toxicity filters and safe-completion checks.
RPA & test automation
UiPath attended/unattended bots and Orchestrator, Selenium regression, API-first automations, event-driven reconciliation and mainframe (3270/CICS) interaction.
Analytics & MLOps
Claims and eligibility data lakes, FMAP and CMS-64 cost analytics, FWA feature stores, model registries, drift monitoring and zero-downtime rollouts.
Use cases we have built
- Eligibility & enrollment agent with ex-parte renewal support
- Claims adjudication agent with 835-aligned remittance views
- Appeals & grievances triage with CMS timeline tracking
- Fraud, waste & abuse detection with risk-scored alerts
- Member-services chatbot with secure human handoff
- Prior authorization agent with confidence-based routing
- FMAP cost reporting & analytics with auto-generated CMS-64
- Communications mining for reportable events in behavioral health
- RPA for data entry, mainframe modernization and test automation
How an engagement runs
Access & environments
Week 1: environments, access and data agreements in your cloud or on-prem.
Pilot
Weeks 2–4: connect key systems (MMIS, CRM, hubs), run UAT with real caseworkers.
Scale
Weeks 5–8: expand programs; track throughput, error rate, on-time percentage and worker satisfaction.
Operate
99.9% availability targets, change-controlled model and prompt updates with rollback, drift monitoring.