Agentic claims and payment workflows.
Diagrid gives health plans the identity, policy, durability, and cost control to run AI agents across claims adjudication, prior authorization, payment integrity, and benefit selection without the governance gaps that block production.
No credit card required · HIPAA, SOC 2, and ISO 27001 environments
High-impact agent workflows
The reality
We Know Your Pain
Agents that can't prove what they did
“Our auditor asked which agent recommended the denial, what data it pulled, and who approved the final action. We couldn't answer in less than two days.”
Claims and prior auth agents call dozens of internal tools and member data sources per decision. Without per-agent identity and per-call audit logs, every regulator question turns into a forensic exercise across application logs.
Agent runs that fail mid-adjudication
“A timeout to the eligibility service halfway through the run, and the whole multi-step adjudication starts over. Sometimes it duplicates the determination. Sometimes it just gets lost.”
Multi-step agent workflows that span eligibility, benefit, clinical review, and payment integrity must be durable. Restarting from scratch is not acceptable when the run took eight minutes and called four LLMs.
LLM costs that scale linearly with member volume
“Our prior auth agent burns through tokens running the same five clinical queries against the same policies a thousand times a day. The cost trajectory does not pencil.”
Repeated semantic queries against unchanged clinical guidelines, plan documents, and policy text waste LLM spend. Without semantic caching at the data plane, every member case pays the full provider call.
Workflows
High-impact agent workflows for health plans
Zero-trust security. Automatic recovery.
Claims Adjudication
Orchestrated claims agents that survive retries and failures
An eligibility agent, a benefit agent, a clinical review agent, and a payment integrity agent run in sequence with stage gates between each step. Catalyst gives every agent a cryptographic identity, every tool call a policy, and every step a durable checkpoint.
Prior Authorization
Prior auth agents with policy enforcement at every hop
An intake agent structures the request, a clinical review agent retrieves and applies guideline criteria, a confidence-scoring agent decides whether the case routes to a human reviewer or to an auto-approval. Catalyst enforces which clinical sources each agent can access and which actions each can take.
Payment Integrity
Payment integrity agents that are observable end-to-end
Specialized agents structure unstructured clinical documentation, recommend findings against policy, and pass low-confidence cases to human reviewers. Every retrieval, every recommendation, and every escalation is logged with agent identity and timestamp.
Benefit Selection
Member-facing agents with strict guardrails on what they can say
For Medicare Advantage, ACA, and commercial plans, agents align benefits to member context and produce tailored education materials. Catalyst policies enforce which member data each agent can read and which actions can be taken without a licensed broker in the loop.
Care Management
Clinical review agents that don't drop members between handoffs
Agents structure clinical data, summarize histories, and recommend interventions. The Workflow API checkpoints state at every step, so a member case never gets lost when a downstream service times out or a model provider rate-limits.
Contact Center
Member service agents that initiate the right downstream workflow
Note-taking, member identification, grievance and appeals routing, policy retrieval. Instead of siloed copilots, Catalyst lets one agent kick off the next workflow with full audit trail across the handoff.
The answer
How Diagrid Helps
Identity and policy for every agent and tool
Every claims agent, prior auth agent, and member-facing agent gets a verifiable identity. Policies define which member data sources, clinical guidelines, and downstream tools each agent can access. Shadow agents touching PHI without authorization stop being a category of incident.
Durable execution across every step
Multi-step adjudication and prior auth runs survive timeouts, rate limits, and downstream failures. The Workflow API checkpoints state at every step. A run that fails at step seven resumes from step seven, not from zero. Determinations never get duplicated and member cases never get silently dropped.
Cost control at the data plane
Repeated semantic queries against the same clinical guidelines, plan documents, and policy text get cached at the data plane and never hit the provider. Unlike API gateway caching that still pays for the call and expires in 24 hours, Diagrid's semantic cache works across providers and has no time limit, with documented LLM spend reductions of up to 70%.
Audit trail that satisfies regulators
Every agent invocation, every tool call, every retrieval, every determination is logged with agent identity and timestamp. When a CMS auditor or a state regulator asks which agent recommended what action against which member case, the answer is one query away, exportable to Splunk or any SIEM.
Move agents into production
without the governance backlog
Health plans on Diagrid stop choosing between pilot velocity and audit-readiness. The governance is built in, the durability is built in, the cost control is built in.
Without Diagrid
- Agents calling member data, clinical guidelines, and downstream tools without consistent identity, policy, or rate limits, and no way to see who did what
- Multi-step adjudication runs that restart from zero on a single timeout, sometimes duplicating determinations and sometimes silently losing member cases
- LLM spend that scales linearly with member volume because the same five guideline queries run a thousand times a day with no cache
- Each agent framework reinventing identity, retry, observability, and policy enforcement, leaving every new agent as a one-off integration project
- No unified audit trail across agent decisions, tool calls, and human handoffs, making every regulator question a multi-day reconstruction effort
With Diagrid
- Cryptographic identity for every agent, policy enforcement on every tool call, and centralized governance that platform and security teams configure once
- Durable Workflow API checkpoints every step, so adjudication runs resume exactly where they failed and member cases are never lost or duplicated
- Semantic caching at the data plane that avoids the provider call entirely, works across providers, and reduces LLM spend by up to 70%
- Three lines of code makes any agent framework durable, including Microsoft Agent Framework, with identity and policy enforced without application code
- Immutable audit logs covering every agent invocation, tool call, and human handoff, exportable to Splunk or any SIEM, ready for any audit on demand
We have Compliance Covered
HIPAA
Privacy & Security
PCI DSS
Standard
SOC 2
Type II
Frequently asked questions
Common questions from platform engineers, security architects, and clinical operations leaders at health plans evaluating Catalyst for agentic workflows.
Ready to Move Payer Agents Into Production?
Talk to our team about how Diagrid Catalyst can help you govern, run, and audit multi-step agent workflows across claims, prior auth, and member-facing experiences.