ArmorHealth Policy Studio
Customize health insurance compliance policies with the 11-section editor - coverage rules, claims processing, provider networks, PHI access, and more.
Overview
The ArmorHealth Policy Studio at /dashboard/armorhealth/studio provides a specialized editor for health insurance compliance policies. It extends the standard Policy Studio with 11 health-specific sections.
Editor Sections
The left panel lists 11 sections. Click any to switch:
1. Metadata
| Field | Description |
|---|---|
| Policy Name | Name for this health policy |
| Description | What this policy controls |
| Target Agent | The health agent this policy applies to |
2. Member Targeting
| Setting | Description |
|---|---|
| Target Mode | all (apply to all members) or specific (select individual members) |
| Selected Members | When specific, choose which members this policy applies to |
3. Coverage Rules
| Field | Description |
|---|---|
| Plan Type | HMO, PPO, EPO, POS, HDHP |
| Deductible | Annual deductible amount |
| Copay | Per-visit copay amount |
| Out-of-Pocket Maximum | Annual OOP limit |
| Coinsurance | Percentage the plan pays after deductible |
4. Claim Processing
| Field | Description |
|---|---|
| Auto-Approve Threshold | Claims below this amount are auto-approved |
| Manual Review Threshold | Claims above this amount require manual review |
| Clinical Review Threshold | Claims above this amount require clinical review |
| Appeal Window | Number of days allowed for appeals (e.g., 180 days) |
| Denial Categories | Categories of denials the agent can issue |
5. Provider Network
| Field | Description |
|---|---|
| Network Strictness | How strictly to enforce in-network providers (e.g., HMO strict vs. PPO flexible) |
| Out-of-Network Penalty | Reimbursement percentage for OON providers |
| Quality Score Minimum | Minimum provider quality rating required |
| Referral Requirements | Whether referrals are required for specialists |
| Distance Limit | Maximum provider distance in miles |
6. Prior Authorization
| Field | Description |
|---|---|
| Procedure Codes | Procedures requiring prior authorization |
| SLA Days | Maximum days to process a prior auth request |
| Urgent Review | Whether urgent/expedited review is available |
| Clinical Notes Required | Whether clinical documentation must accompany the request |
7. Risk Stratification
| Field | Description |
|---|---|
| HCC Score Threshold | Hierarchical Condition Category score for flagging high-risk members |
| Risk Tiers | Defined risk levels (low, moderate, high, critical) |
| Chronic Care Flags | Conditions that trigger chronic care management |
| Readmission Window | Days within which a re-admission is flagged (e.g., 30 days) |
| Care Gap Detection | Types of care gaps to identify and flag |
8. PHI Access Control
| Field | Description |
|---|---|
| Minimum Necessary | Enforce minimum necessary standard for PHI access |
| Data Categories | Which PHI categories the agent can access (demographics, clinical, financial) |
| SSN Redaction | Whether Social Security Numbers are redacted |
| Financial Redaction | Whether financial details are redacted |
| Audit Trail | Whether all PHI access is logged |
| Max Records Per Query | Maximum number of patient records returned per query |
9. Delegation Approval
| Field | Description |
|---|---|
| Approver Roles | Which roles can approve delegated actions |
| Approval Channels | How approvals are routed (in-app, email, etc.) |
| Approval Limits | Dollar or action thresholds requiring approval |
10. Enforcement
| Field | Description |
|---|---|
| Default Action | What happens when no specific rule matches: block, hold, allow_log, allow |
| Rate Limit | Global requests-per-hour limit for this agent |
11. YAML Editor
The right panel shows a live YAML preview of the compiled HealthPolicy document. Changes in the form update the YAML in real time, and vice versa.
- Copy - Copy YAML to clipboard
- Download - Download as
.yamlfile
Draft Persistence
Your work is auto-saved to browser localStorage. Come back later to continue editing. Use Clear Draft to start fresh.
Saving
Click Deploy Policy to save and activate the health policy.
ArmorHealth Dashboard
Select health agents, browse compliance bundle templates, and apply health insurance policies with one click.
ArmorHealth Bundle Templates
Reference guide for all pre-built ArmorHealth policy bundles - provider steering, site-of-care steering, claims, benefits, and risk stratification templates.