Claims platform evidence
you can inspect.
Cloud Health Office is source-available payer infrastructure with a published clean 100,000-claim local Kubernetes validation:
zero platform failures, zero scoreable mismatches, zero unexpected pends, and every comparable payment within one cent.
Deployable in your cloud for technical evaluation and pilot-scoped engagements.
Compliance still matters. Evidence makes it credible.
CMS-0057-F raises the bar for payer interoperability, prior authorization APIs, payer-to-payer exchange,
and operational auditability. Teams that wait until the compliance window is fully open will spend the following year
reconciling vendors, interfaces, and evidence after the fact.
The organizations that engage now — validating workflows, building attribution logic, proving
interoperability, and testing real adjudication behavior — will enter the compliance window with evidence,
not only vendor promises.
Founding Client Program
We are selecting one healthcare organization to become our Founding Client. Your organization will deploy Cloud Health Office in your own cloud environment, receive zero software licensing fees during the founding engagement, and work directly with our engineering team to prioritize future capabilities while implementing CMS-0057-F and modern health plan operations.
Zero Software Licensing
No licensing fees during the founding engagement. Host on your Azure, AWS, or GCP subscription. You own your data — and retain full ownership permanently, regardless of the vendor relationship.
Direct Engineering Access
Work side-by-side with the product engineering team. Your operational priorities become sprint priorities. Implementation assistance and priority support are included throughout the engagement.
Roadmap Influence
Shape the direction of the platform from the inside. As our Founding Client, you gain early access to new capabilities and the opportunity to help define what gets built next.
CMS-0057-F Pilot Path
Validate documented, tested implementations of prior authorization APIs, payer-to-payer exchange, and provider access APIs — before the compliance window closes.
Early Adopter Advantage
Be first to market with a fully integrated, cloud-native health plan administration platform. Optional opportunity to serve as a reference customer and establish category leadership.
Enterprise-Grade Controls
HIPAA-oriented controls, RBAC, audit logging, and deployment isolation from day one. Built for health plan compliance requirements — not retrofitted after the fact.
We are selecting one Founding Client. Engagement is limited and evaluated on fit.
How It Works
From application to a scoped pilot in under 8 weeks — in your own cloud subscription.
Apply and align on scope
We learn your current stack, your CMS-0057-F priorities, and the workflows that matter most. Together we define a focused first milestone.
1–2 weeks
Deploy to your subscription
We handle the full infrastructure setup in your Azure, AWS, or GCP environment. Your team watches and approves — no black-box vendor access, no data ever leaves your walls.
2–4 weeks
Validate & co-develop
Your team validates the platform in a production-shaped environment. We run joint sprints to build out workflows, tune attribution logic, and prioritize your roadmap based on measurable findings.
Ongoing collaboration
Built for payer infrastructure.
Cloud Health Office is the compliance and modernization layer for health plans, TPAs, and payer operations teams running on legacy core admin systems.
CMS-0057-F Compliance
Compliance surface for the CMS Interoperability and Prior Authorization Rule, deployable alongside existing core admin systems without replacing the adjudication path.
Multi-Clearinghouse EDI
Multi-clearinghouse integration patterns for Availity, Change Healthcare, Optum, and Inovalon, with source-visible implementation and configurable routing.
X12 to FHIR R4 Transformation
Automated transformation of X12 EDI transactions (270/837/278/835) to FHIR R4 resources, designed for repeatable validation and tenant-aware operation.
Legacy Core Augmentation
Sits alongside QNXT, Facets, HealthEdge, or Amisys. Reads from your existing system, exposes FHIR R4 APIs — without touching your core operations.
HIPAA-Grade Security
BAA-ready operating model, automated dependency scanning, encryption, PHI-aware telemetry controls, audit trails, and compliance reporting foundations.
Flexible Deployment
Kubernetes-native architecture with Argo Workflows on AKS, EKS, or GKE. Container-based microservices with full infrastructure ownership. Deploy to your own subscription.
Premium Billing & ACH
Automated monthly premium invoicing with NACHA/ACH file generation, EFT draft lifecycle management, and Stripe ACH integration. Batch billing runs with sponsor-level invoicing and audit trails.
“Our Founding Client won’t be evaluating a slide deck — they’ll validate a production-shaped platform, running in their own environment, under their own control, at zero licensing cost.”
Apply for the Founding Client Program
Tell us about your organization and your CMS-0057-F priorities. We respond to every application personally within 2 business days.
Four product lines.
One platform.
Cloud Health Office engages customers across four complementary product lines, each a coherent offering on its own, each connecting naturally to the next. Enter where the pain is. Expand where the leverage is.
Public Tools
Free utilities. No signup.
Fee schedule lookup and free-tier claims repricing. Verify the calculation engines before any commercial conversation begins.
Transactional Services
Per-call APIs. Self-serve subscription.
Claims Repricing API and Pricing API for developers, billing companies, TPAs, and integrators. Free tier flows to paid tier on usage.
Managed Data Services
Subscription data. Recurring value.
State Medicaid compliance updates, CMS fee schedule updates, provider verification, terminology mapping. Healthcare data that changes constantly — tracked for you.
Platform Engagement
Payer-scale. Priced PMPM.
Multi-year relationships priced per member per month, across three layers: Compliance Accelerator, Progressive Modernization, and Full CAPS Platform.
See POSITIONING.md for the canonical framing.
Three layers.
One Platform Engagement.
Within Platform Engagement, Cloud Health Office engages customers at three layers, each a coherent product on its own, each containing the previous. Meet us where your constraints are.
Layer 1 — Compliance Accelerator
Meet CMS-0057-F without replacing your core.
FHIR compliance surface deployable alongside your existing QNXT, HealthEdge, or Facets. Weeks-to-deploy pilot path.
Layer 2 — Progressive Modernization
Replace your legacy core, one domain at a time.
The strangler-fig path — your system of record stays stable while Cloud Health Office takes over appeals, then capitation, then claims, at your pace. Appeals shipped and validated first.
Layer 3 — Full CAPS Platform
End-to-end cloud-native claims administration.
36 services, 9 engines, Argo-orchestrated adjudication, full X12 EDI. For new entrants today; for established payers, the milestone after Layer 2.
Not sure where to start? See POSITIONING.md.
Claims Work Queues — NCCI/MUE edits, prior auth, COB, provider contracting, and medical review. Cloud Health Office
Validation
Failures
Mismatches
Within One Cent
The proof ladder is public.
The Million Claim Challenge is designed for one million deterministic synthetic claims across professional, institutional, dental, and 29 named edge-case scenarios. The latest published Cloud Health Office proof is the clean 100K local Kubernetes run: every claim processed, zero platform failures, zero scoreable workflow mismatches, zero unexpected pends, and every comparable payment within one cent.
Matched
Pends
Separated
Delta
Current proof, next bottleneck.
The 100K result is a local Docker Desktop Kubernetes validation, not a production cloud capacity claim and not the full million yet. It proves the stronger scoring gates can hold at 100K, while exposing the next local bottleneck: fixture preparation dominated the total job lifecycle. That is the next optimization target before 250K, 500K, and the full million.
CMS-0057-F Surface, Source Visible.
The compliance APIs are implemented and inspectable today. Production readiness, integrations, and operating evidence should be validated in each payer environment.
Be Ready for CMS-0057-F.
On your terms.
Deploy in your cloud. Go live with your team. Move without betting your operations on a replatform.