Policy-driven incentives for measurable healthcare operations
The demo use cases below show how healthcare teams can earn contract incentives only when policy-safe evidence proves quality, timeliness, completeness, and audit readiness.
Business policies decide whether work qualifies. Payment policies enforce financial controls: approved recipients, caps, tokens, human-review rules, prohibited metrics, and audit-safe settlement.
Provider Documentation Completeness
Reward complete prior-auth-ready documentation submitted before initial decision.
Delegated UM vendorDelegate UM SLA Bonus
Reward timely, complete, audit-ready delegated utilization-management work.
Specialty pharmacySpecialty Rx Fulfillment SLA
Reward contracted specialty pharmacy fulfillment that clears, schedules, and confirms approved therapy within SLA without avoidable exceptions.
Provider appeals teamAppeals Packet Quality
Reward complete, timely, well-rationalized appeal packets without outcome incentives.
Built for the Hedera AI Agent Bounty Campaign using synthetic healthcare data and controlled settlement policies.