A newly printed Request for Info (RFI) gives a glimpse into the methods the Facilities for Medicare and Medicaid Companies (CMS) is envisioning utilizing synthetic intelligence within the Medicare program throughout each digital and voice channels.
The RFI, which has a response deadline of March 31, 2026, notes that present instruments utilized by CMS rely totally on static comparability tables and paperwork that may be tough to navigate, significantly for beneficiaries with restricted well being literacy, language boundaries, or cognitive challenges. Throughout peak enrollment durations, wait occasions on the name middle could also be longer as name middle representatives should clarify the various quantity of protection choices and well being plan sorts orally over the telephone.
CMS seeks to leverage rising AI applied sciences to supply personalised, claims-informed plan suggestions based mostly on particular person well being wants, drugs, supplier preferences, and precise utilization patterns and provide real-time conversational AI assist by way of chatbots, digital assistants, and AI voice advisors which might be out there 24/7.
This may contain utilizing predictive analytics to match beneficiaries with plans which might be prone to meet their wants and translating complicated plan data and Medicare paperwork into accessible, plain-language explanations.
On the decision middle entrance, it could automate routine name middle inquiries whereas seamlessly escalating complicated instances to human customer support representatives and allow 100% name high quality assurance by way of AI-powered name evaluation and sentiment detection.
Stressing that the RFI just isn’t a solicitation for proposals, CMS stated its targets are to establish distributors with production-ready, Medicare-specific AI/ML capabilities for healthcare resolution assist and name middle automation and to know the present state of business AI options for Medicare plan choice and beneficiary assist.
CMS stated it additionally needs to assemble details about AI approaches to plan advice, conversational assist, predictive analytics, and name middle intelligence and find out about privacy-preserving AI strategies which might be appropriate for delicate beneficiary knowledge.
The company is also asking resolution suppliers to explain implementation methodology and timeline for a phased rollout technique from pilot to nationwide scale and the required knowledge and integration factors.
