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Cloud Health Office Sentinel Logo - Obsidian monolith shield with digital eye and circuit veins

Cloud Health Office Platform

Compliance & Modernization Layer for Legacy Payer Core Systems

v4.0.0 Production Ready • Augment mode live. Modular replacement when you’re ready.

Compliance First. Modernization on Your Terms.

Cloud Health Office is a source-available, Azure-native, HIPAA-engineered compliance layer that deploys alongside your existing core admin system in under one hour (based on internal testing) — delivering CMS-0057-F readiness without replatforming. Activate modular capabilities over time as your modernization roadmap evolves.

<1hr
Deployment Time
(vs. 6-18 months)
Self-Service
Configuration-Driven
Onboarding
82%
5-Year TCO Reduction
∞
Multi-Payer Tenants
(Complete Isolation)
Product Line Context

One Platform. Four Product Lines.

The Cloud Health Office (CHO) platform is the technical substrate underlying all four CHO product lines. The same FHIR services, X12 engines, calculation engines, and Argo-orchestrated workflows you'll see described below power every commercial surface CHO ships.

Public Tools — free fee-schedule lookup and free-tier claims repricing — run on the platform's Pricing API and FeeScheduleEngine. Same code, free tier.

Transactional Services — per-call APIs (Claims Repricing, Pricing) for developers, billing companies, TPAs, and integrators — expose the same engines via metered, self-serve subscription. Every API call exercises the production calculation paths under real load.

Managed Data Services — subscription services for state Medicaid updates, CMS fee schedule updates, provider verification, and terminology — productize the platform's ingestion and normalization pipelines as recurring-value data products.

Platform Engagement — payer-scale deployments priced per member per month (PMPM) — engages the entire platform across three layers: Layer 1 — Compliance Accelerator (CMS-0057-F surface alongside legacy core), Layer 2 — Progressive Modernization (domain-by-domain Augment or Replace), and Layer 3 — Full CAPS Platform (cloud-native end-to-end claims administration).

The capabilities documented on this page are the substrate. The four product lines are the commercial surfaces. Read the rest of this page as the architecture; read the links below for how it sells.

See full pricing across all four product lines →  ·  Canonical positioning (POSITIONING.md) →

Core Capabilities

Production-ready EDI processing for all major transaction types. No custom code. No vendor lock-in.

Real-Time Prior Authorization

  • 278 Health Care Services Review
  • Sub-2-minute processing (<12 days)
  • Automated claims adjudication systems correlation
  • Complete audit trail
  • Zero manual intervention

Claims Processing

  • 837P/I/D (Professional, Institutional, Dental)
  • Automated X12 validation
  • Real-time status updates
  • Deterministic replay endpoint
  • PHI-redacted Application Insights

Eligibility Verification

  • 270/271 real-time eligibility
  • leading clearinghouses
  • Sub-second response times
  • Backend system correlation
  • 99.9% uptime SLA

Enhanced Claim Status (ECS)

  • X215 Authorization Inquiry
  • X217 Authorization Request
  • Real-time status tracking
  • Historical lookup capabilities
  • NCPDP and HIPAA format support

Appeals Integration

  • 277 RFAI automated generation
  • 275 Attachment processing
  • Deadline tracking and notifications
  • Complete audit trail
  • Regulatory compliance built-in

Security That Passes Audits

  • Private endpoints everywhere
  • HSM-backed Key Vault Premium
  • DCR-based PHI redaction
  • Immutable audit logs (7-year retention)
  • Managed identities only

Premium Billing & ACH

  • Monthly premium invoicing per sponsor group
  • NACHA/ACH file generation (CCD format)
  • EFT draft lifecycle: Pending → Settled / Returned
  • Stripe ACH integration with webhook processing
  • Batch billing runs with audit trail

Inside the Platform

This Is What Production Looks Like

Not a mockup. Not a pitch deck. The Sentinel v4.0 — live claims adjudication, work queues, prior authorization, eligibility verification, and CMS-0057-F compliance running in production.

portal.cloudhealthoffice.com/operations/dashboard
Cloud Health Office Operations Dashboard showing 14,892 total claims, 87.3% approval rate, 1.2 second average processing time, and $4.2M total plan paid
14,892
Claims processed with full audit trail, real-time status tracking, and compliance metadata.
87.3%
Auto-adjudication rate. Denied and pended claims route to examiner work queues automatically.
1.2 sec
Average end-to-end claim processing. Eligibility, benefit resolution, pricing, and adjudication.
$4.2M
Total plan paid. Real-time financial visibility across all claim types and benefit plans.

Platform Architecture

29 Microservices. One Adjudication Pipeline.

Cloud Health Office runs as a sidecar to your existing CAPS — QNXT, Facets, or HealthEdge. X12 EDI in, FHIR R4 out, with full claims adjudication, prior auth, eligibility, and CMS-0057-F compliance running on Azure Kubernetes Service.

Cloud Health Office platform architecture — 29 C# microservices on Azure Kubernetes Service with X12 EDI intake, FHIR R4 APIs, claims adjudication pipeline, and CMS-0057-F compliance layer

Financial Operations

End-to-End Payer Financial Lifecycle

Accounts receivable, capitation management, premium billing with NACHA/ACH, and fee-for-service payment runs with 835 ERA generation — all native to the platform.

portal.cloudhealthoffice.com/finance/ar-balances
Cloud Health Office AR Balances — period balances, aging buckets (Current through 120+ Days), sponsor and member balances, reconciliation status across 142 accounts
$1.6M
Total outstanding AR across 142 sponsor group accounts with full aging visibility.
53%
Current (0-30 days). Healthy AR aging with automated reconciliation and period close.
Debit/Credit
Double-entry GL integration. Opening + debits - credits = closing balance every period.
Split View
Sponsor balance vs. member balance breakout with one-click reconciliation.

See How It Works With Your Core System

Detailed technical analysis of augmentation mode, compliance deployment, and long-term modernization roadmap.

CMS-0057-F compliant in weeks. No changes to existing operations. Gradual path to modular replacement.

For Health Plans → Contact Sales

Architecture Overview

Kubernetes-native infrastructure leveraging Argo Workflows on AKS, Service Bus, Data Lake Gen2, and container-based microservices for complete X12 transaction processing.

Deployment Components

  • Argo Workflows on AKS: Kubernetes-native workflow orchestration for all EDI transaction types
  • Service Bus: Event-driven architecture with topics for pub/sub patterns
  • Data Lake Gen2: Hierarchical namespace for organized PHI storage
  • Integration Account: X12 schema validation and trading partner agreements
  • Key Vault Premium: HSM-backed key management with soft-delete + purge protection
  • Application Insights: Telemetry with DCR-based PHI redaction
  • Private Endpoints: No public IP addresses exposed

Multi-Tenant Architecture

Each payer tenant receives complete logical isolation while sharing infrastructure efficiency:

  • Dedicated Argo workflow templates per payer
  • Isolated Service Bus topics and subscriptions
  • Separate Data Lake containers with hierarchical paths
  • Individual trading partner configurations
  • Zero shared secrets or configuration

One-Click to Production

Configuration-driven deployment via CLI wizard. No programming expertise required.

# Step 1: Run onboarding wizard (5 minutes)
node dist/scripts/cli/payer-onboarding-wizard.js

# Step 2: Generate infrastructure and workflows (10 minutes)
node dist/scripts/cli/payer-generator-cli.js generate -c payer-config.json

# Step 3: Deploy to Azure (25 minutes)
cd generated/your-payer/infrastructure && ./deploy.sh

# Step 4: Configure trading partners (10 minutes)
./configure-hipaa-trading-partners.ps1

# Total: ~50 minutes from zero to production

Ready to Modernize Your Payer Operations?

Start with CMS-0057-F compliance on your existing core system. Expand to modular replacement at your own pace.

For Health Plans → Clone Repository