Member 360°. Eligibility automation. Program integrity. T-MSIS & CMS-64 reporting — all on a governed AI data foundation.
xAQUA augments your eligibility workers, program integrity team, and policy staff — it does not replace your MMIS, E&E modules, or MES vendors. It sits above them, federates queries across the stack, and turns plain-English intent into governed, auditable answers. Built for state Medicaid agencies with hard CMS, HIPAA, and MITA posture.
State Medicaid agencies cover 1 in 5 Americans across the largest, most fragmented public-program data estate in government. Modernizing the data layer without modernizing every system is the only path that fits the budget.
MMIS for claims, separate E&E for eligibility, encounter data from MCOs, provider registries — each a different vendor and data model. Cross-system questions take days or never get answered.
5–10 vendor systems per statePost-unwinding caseloads stress eligibility workers. Manual verification, renewal processing, and ex parte attempts strain agency staff. Procedural disenrollment risk stays high.
Worker caseloads at all-time highsEnhanced FMAP expired. State general fund spending up sharply. T-MSIS, CMS-64, and program-integrity reporting pull staff away from the work that matters.
Doing more with lessxAQUA does not replace your systems of record. It does not bulk-copy your data. It federates queries with full authority enforcement — and every request is logged, scoped, and replayable.
From front-line operations to federal reporting. xAQUA covers the operational, analytical, and oversight workload across the agency.
Each agent is a specialist. Together they augment your front-line staff, analysts, and oversight team — without replacing the systems they already use.
A unified, governed view of every Medicaid member across eligibility, claims, encounters, and provider interactions — assembled at query time, scoped to the requestor's authority.
PHI handling, 42 CFR Part 2 enforcement, RBAC, and full action audit. The compliance posture CMS audits and state IGs already require — not an afterthought.
Automate ex parte renewals. Predict procedural disenrollment risk. Identify cross-program eligibility. Move workers from data entry to decision-making.
Reconcile MMIS claims with MCO encounters. Detect data-quality issues before they break T-MSIS submission. Catch capitation and rate anomalies before payment cycles close.
Score claims and providers for FWA risk. Detect billing patterns that diverge from peers. Surface high-likelihood candidates for SUR review with explainable features.
Auto-assemble T-MSIS submissions. Generate CMS-64 reports. Executive dashboards on enrollment, spending, and program performance — with narrative commentary and full lineage.
A typical eligibility-worker flow. Same shape holds for program integrity, T-MSIS reconciliation, and policy analysis.
Concrete workflows scoped at peer agencies. Each one is a single use case the platform unlocks — and the platform unlocks dozens more after the first.
Identify members procedurally disenrolled during unwinding who remain eligible. Auto-route outreach lists with verified contact information for re-enrollment.
Comply with 12-month child continuous eligibility. Track windows, automate maintenance, and flag exceptions before they cause coverage gaps.
Encounter data quality, capitation accuracy, network adequacy, and MCO performance — all in one governed view, with HEDIS and quality measures.
Track waiver and institutional services across providers. Coordinate care plans, monitor authorizations, and surface utilization patterns.
Optimize pharmacy program costs. Track MDRP and 340B rebates. Analyze prescription patterns across populations and providers.
Streamline credentialing, track network adequacy, and automate directory maintenance. Surface gaps before members notice them.
Score claims and providers for FWA risk. Surface high-likelihood candidates for SUR. Reduce improper payment rates with defensible models.
Automate T-MSIS data submission with built-in quality checks. Catch issues before federal feedback cycles. Full lineage on every record.
Auto-assemble CMS-64 quarterly reports with audit trail. Optimize FMAP claims. Spend less of every reporting cycle on reconciliation.
Government data carries statutory privacy, federal reporting, and oversight obligations from day one. xAQUA is built for that posture, not against it.
Reference outcomes from peer-agency design conversations and adjacent production deployments on the same platform.
A scoped 30–60 day pilot against your specific use cases. Live in your environment. No PHI egress. We work with state Medicaid agencies on integrated eligibility, program integrity, T-MSIS automation, and unwinding recovery.