skip to content

Automated Eligibility QA

Pre-Determination Review. Full-Caseload Visibility. Configurable, AI-Assisted QA.

HomeHealthProductsAuto.IES™ | Automated Eligibility QA

Auto.IES logo

Auto.IES helps agencies find eligibility errors, procedural issues, documentation gaps, policy-application inconsistencies, and system errors — before they contribute to SNAP QC findings, Medicaid PERM exposure, and federal financial penalties.

A Fundamentally Different Approach to QA

Auto.IES is designed to QA the full eligibility caseload — pre-certification — for a proactive, scalable, defensible QA posture.

Overview: This graphic compares traditional sample-based QA with Auto.IES Penalty-Prevention QA and emphasizes the shift from retrospective control to prevention. The image shows how Auto.IES helps expand review coverage, surface potential issues earlier, and support targeted corrective action. Traditional sample-based QA: The left panel lists sample-based QA limitations: less than 1% of cases may be reviewed, findings are retrospective, errors may already affect SNAP QC or Medicaid PERM, corrective action is broad and delayed, and visibility into true error drivers is limited. Prevention-oriented QA: The right panel shows Auto.IES capabilities: broader and earlier case review, evidence-backed findings before finalization, greater visibility into documentation and verification gaps, targeted corrective action and coaching, and reduced error-rate and federal penalty exposure. The bottom benefits are earlier detection, better documentation, targeted intervention, and reduced federal exposure. Findings Auto.IES Can Surface

Identify where errors come from — staff, process, or system.

  • Eligibility Issues

    Income, household, citizenship, address, resources, work hours, arrests, incarceration, TPL. Potential categorical, resource, or program-specific eligibility discrepancies are flagged before they become findings.

  • Procedural Issues

    Missed notices, incomplete steps, unresolved verification, mistimed actions

    Procedural gaps that can trigger SNAP QC or Medicaid PERM findings without triggering an obvious eligibility error.

  • Documentation Gaps

    Missing, inconsistent, or insufficient documentation.

    Documentation issues that disproportionately drive Medicaid PERM insufficient-evidence findings.

  • Calculation Errors

    Income, deductions, shelter, utility, benefit level.

    Benefit-calculation discrepancies across income types, deductions, and household configurations.

  • Policy Inconsistencies

    Same rule, different outcomes across workers or offices.

    Patterns where policy is applied differently across workers, units, offices, or programs.

  • System Issues

    Incorrect system-generated actions or calculations.

    System-driven errors distinguishable from staff errors — the finding that retraining alone will never fix.

QA Workflow

Five steps, fully outside the determination workflow.

STEP 1

AI-driven case analysis

Cases evaluated against state-configured policy, rules, thresholds, and procedural logic.

STEP 2

Evidence-backed findings

Each finding includes policy basis, source evidence, confidence score, and resolution path.

STEP 3

Human QA review

Reviewers confirm, override, escalate, or resolve. Human authority at each material step.

STEP 4

Standardized resolution

Controlled resolution codes strengthen reporting, trend analysis, and corrective-action planning.

STEP 5

Error-rate reporting

Dashboards track error categories, office-level trends, training needs, and PERM/QC exposure.

 

Book a Demo

* indicates a required field

This field is for validation purposes and should be left unchanged.
Name*
Email*