AI Benefits Enrollment Extraction Agent

How Cassidy automates FNOL Claims Intake using AI

Step 1: Ingest and classify enrollment documents

The Workflow triggers when new enrollment artifacts arrive—via secure email, SFTP, employee self-service uploads, or broker portals. Cassidy automatically classifies each document (enrollment form, dependent add, waiver, QLE proof, COBRA election) and routes it for processing.

Step 2: Extract and normalize enrollment data

Cassidy's template-free extraction pulls key fields—member demographics, plan elections, dependent details, effective dates, and QLE documentation—regardless of form layout. Free-text and checkbox values are normalized to canonical codes for coverage tiers, maintenance reasons, and carrier-specific identifiers.

Step 3: Validate against business rules

The Workflow applies structural and semantic checks: required fields by product, date logic, dependent eligibility rules, SSN formats, waiting periods, and plan mapping. Records with critical gaps route to a Human-in-the-Loop exception queue where reviewers see the original form alongside parsed fields.

Step 4: Compute deltas and maintain the eligibility ledger

Cassidy compares extracted data against the golden eligibility record for each member and dependent, detecting true adds, changes, and terminations. Only actual deltas flow forward—reducing carrier file noise and reconciliation burden.

Step 5: Generate carrier-compliant 834 transactions

The Workflow builds HIPAA X12N 834 files per carrier, applying correct envelope settings, BGN purpose codes, INS/HD/DTP segments, and companion guide requirements. SNIP-level validation runs automatically before any file leaves the system.

Step 6: Transmit and process acknowledgments

Cassidy sends 834 files via AS2 or SFTP on carrier-specific schedules, then monitors for TA1 and 999 acknowledgments. Rejections trigger automatic requeue with error visibility, while successful transmissions update the eligibility ledger.

Step 7: Reconcile and report

Post-send, Cassidy compares outbound 834s against carrier acknowledgments and census files, surfacing variances and drift. HR teams receive delta reports, exception worklists, and reconciliation summaries—with full audit trails for compliance.