ArmorHealth Bundle Templates

Overview

ArmorHealth ships with 12 pre-built bundle templates - three per health agent. Each bundle represents a different compliance posture.

Provider Ranking Templates (Member Care Navigator)

Standard Provider Steering

• ID: provider-ranking-standard
• Enforcement: allow_log
• Key Rules:
  • Prefer in-network providers
  • Quality score minimum: 3.0
  • Out-of-network referrals allowed (with logging)
  • 50-mile search radius

Strict Network Steering

• ID: provider-ranking-strict
• Enforcement: block
• Key Rules:
  • HMO-style: in-network only
  • Quality score minimum: 4.0
  • Out-of-network referrals blocked
  • 25-mile search radius

Open Network Access

• ID: provider-ranking-open
• Enforcement: allow_log
• Key Rules:
  • PPO-style: OON at 80% reimbursement
  • Quality score minimum: 2.0
  • 100-mile search radius

Claims Explanation Templates (Claims Accuracy Copilot)

Standard Claims Access

• ID: claim-explain-standard
• Enforcement: allow_log
• Key Rules:
  • Auto-approve claims under $500
  • Manual review for claims over $5,000
  • 180-day appeal window
  • Standard EOB access

Restricted Claims Access

• ID: claim-explain-restricted
• Enforcement: hold
• Key Rules:
  • All claims held for review
  • Status-only access (no financial details)
  • No auto-adjudication

Full Claims Transparency

• ID: claim-explain-full
• Enforcement: allow_log
• Key Rules:
  • All tools enabled
  • Auto-adjudication allowed
  • Full Explanation of Benefits (EOB) access

Benefit Suggestion Templates

Standard Benefit Analysis

• ID: benefit-suggest-standard
• Enforcement: allow_log
• Key Rules:
  • Cost driver analysis enabled
  • Plan comparison enabled
  • Industry benchmarks available

Restricted Benefit Analysis

• ID: benefit-suggest-restricted
• Enforcement: hold
• Key Rules:
  • Aggregate data only
  • No cost modeling
  • No individual member data access

Full Benefit Modeling

• ID: benefit-suggest-full
• Enforcement: allow_log
• Key Rules:
  • All analysis tools enabled
  • Plan modeling and projections
  • Cost trend forecasting

Risk Stratification Templates

Standard Risk Screening

• ID: risk-strat-standard
• Enforcement: allow_log
• Key Rules:
  • HCC threshold: ≥1.5
  • High-risk threshold: ≥3.0
  • 30-day readmission window
  • Standard care gap detection

HIPAA-Strict Risk Assessment

• ID: risk-strat-hipaa-strict
• Enforcement: hold
• Key Rules:
  • Maximum PHI protection
  • 10-record limit per query
  • All access held for review
  • Full audit trail required

Comprehensive Risk Analysis

• ID: risk-strat-comprehensive
• Enforcement: allow_log
• Key Rules:
  • All risk tools enabled
  • HCC threshold: ≥1.0 (broader capture)
  • All risk tiers included
  • Expanded care gap categories

YAML Structure

All ArmorHealth bundles compile to a HealthPolicy kind YAML document:

kind: HealthPolicy
metadata:
  name: "Standard Provider Steering"
  targetType: agent
  targetId: member-care-navigator
enforcement:
  defaultAction: allow_log
  rateLimit: 100
healthRules:
  providerNetwork:
    networkStrictness: moderate
    oonPenalty: 0.7
    qualityMinimum: 3.0
    distanceLimit: 50
  claimProcessing:
    autoApproveThreshold: 500
    manualReviewThreshold: 5000
    appealWindow: 180
  phiAccess:
    minimumNecessary: true
    ssnRedaction: true
    maxRecordsPerQuery: 50

The healthRules object contains domain-specific sections that map directly to the Policy Studio editor sections.