ArmorHealth Bundle Templates

Overview

ArmorHealth ships with 16 pre-built bundle templates across four health agents. Member Care Navigator has two template groups (provider ranking and site-of-care steering) for a total of six; Claims Accuracy Copilot has four; Benefit Suggestion Agent and Risk Stratification Agent each have three. 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

Site-of-Care Steering Templates (Member Care Navigator)

Three additional Member Care Navigator bundles optimize where a procedure happens rather than which provider handles it. All three allow the comparison and cost-estimate tools and hold the actual scheduling/coordination step for approval.

Imaging Site Optimization

• ID: imaging-site-steering
• Enforcement: allow_log default, hold on scheduling
• Key Rules:
  • Compare freestanding imaging vs. hospital outpatient for the same study
  • Estimate member out-of-pocket cost and check clinical appropriateness (allowed)
  • schedule_appointment held for approval
  • Quality score minimum: 3.5

Infusion Site Optimization

• ID: infusion-site-steering
• Enforcement: allow_log default, hold on coordination and scheduling
• Key Rules:
  • Move stable infusion members from hospital outpatient to ambulatory or home infusion when clinically appropriate
  • coordinate_care, monitor_therapy, and schedule_appointment held for approval

Ambulatory Surgery Center Steering

• ID: asc-steering
• Enforcement: allow_log default, hold on scheduling
• Key Rules:
  • Shift eligible outpatient procedures from hospital outpatient departments to ambulatory surgery centers when clinically suitable
  • schedule_appointment held for approval

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

Claims Payment Determination

• ID: claims-payment-determination
• Enforcement: allow_log
• Key Rules:
  • Claimless adjudication and pre-pay audit allowed
  • Prices against the fee schedule and medical-edit rules
  • generate_payment_determination and propose_recoupment (post-pay recoupment above $100K) held for approval

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 are authored as a HealthPolicy kind YAML document:

apiVersion: armor.io/v1
kind: HealthPolicy
metadata:
  name: "standard-provider-steering"
  orgId: "<your-org-id>"
  targetType: agent
  targetId: "<member-care-agent-id>"
spec:
  priority: 100
  status: active
  defaultEnforcementAction: allow_log
  memberRules:
    "*":
      allowedTools: [search, read, propose_oon_referral]
      toolEnforcement:
        propose_oon_referral: hold
      healthRules:
        providerNetwork:
          networkStrictness: preferred
          oonPenaltyMultiplier: 0.7
          qualityScoreMinimum: 3.0
          maxDistanceMiles: 50
        claimProcessing:
          autoApproveBelow: 500
          manualReviewAbove: 5000
          appealWindowDays: 180
        phiAccess:
          minimumNecessary: true
          redactSsn: true
          maxRecordsPerQuery: 50

On import, the backend normalizes this into a standard Policy document, flattening healthRules directly into the matching memberRules entry alongside allowedTools and toolEnforcement. See Concepts for the full field reference and the enforcement resolution order.