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.