Context-Aware Answers
Reads the active case, lead, alert, document, or dataset context from the investigator's current screen. No manual context selection required — the AI understands case history, evidence status, and workflow stage.
AI
AEGIS AI
AI that works from the active case, alert, document, or dataset.
AEGIS AI is not a generic chatbot. It reads the active investigation context from the screen you are viewing and provides evidence-linked answers, action recommendations, and workflow-aware next steps. Cross-product capability that works across Core, Detect, DataBridge, and Drive.
Capabilities
Designed for evidence traceability, not novelty.
Evidence-Linked Responses
Every AI response references specific evidence from the case record. Summaries cite source documents, recommendations reference similar historical outcomes, and risk assessments link to specific fraud indicators.
Action Recommendations
Suggested next steps based on investigation patterns, evidence completeness, workflow stage, SLA deadlines, and historical resolution data. Recommendations respect queue rules and approval requirements.
Graduated Trust Model
Five levels of AI autonomy: Off, Shadow, Suggest, Confirm, and Autonomous. Organizations control the pace of AI adoption by role, action type, and tenant policy. Human-in-the-loop at every level below Autonomous.
Governance & Audit
Per-role trust configuration, approval chains, confidence thresholds, escalation triggers, and full audit logging. Every AI invocation is logged with prompt context, model version, output, evidence cited, and reviewer decision.
Drive Integration
Reads and summarizes documents stored in Drive that are linked to the active case, lead, or review context. AI-generated document summaries include key findings, risk indicators, and recommended follow-up actions.
Graduated AI Trust
Five levels of AI autonomy — you control the pace.
Most healthcare AI tools offer a binary on/off switch. AEGIS AI uses a 5-level graduated trust model that lets organizations adopt AI incrementally, governed by organization policy and user role.
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01
Off
AI capabilities disabled. The platform operates as a traditional investigation tool.
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02
Shadow
AI analyzes cases and generates recommendations silently. Outputs are logged for quality review but never shown to investigators.
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03
Suggest
AI recommendations appear as optional suggestions. Investigators can accept, modify, or dismiss. All interactions are logged.
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04
Confirm
AI proposes specific actions (routing, escalation, document requests) that require explicit investigator approval. Recommended for most production deployments.
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05
Autonomous
AI executes pre-approved action types automatically within defined guardrails. Reserved for high-confidence, low-risk actions like evidence completeness checks.
Trust-model governance
- Trust levels assigned by role, action type, and tenant
- Escalation triggers drop AI to a stricter level per case
- AI Governance settings panel for tenant administrators
- Periodic review metrics: acceptance rate, rejection rate, escalation frequency
- Full audit trail of every AI recommendation and investigator decision
Where AI appears
AEGIS AI works across all products:
- Core — Case summaries, lead triage, medical review support
- Detect — Alert analysis, pattern explanation, scoring context
- DataBridge — Mapping suggestions, quality rule recommendations
- Drive — Document summaries, key findings extraction
Who it's for
AI for every role in program integrity.
- Investigators using Core for case and lead analysis
- Medical reviewers needing document summaries
- Alert analysts triaging Detect alerts
- Data teams working with DataBridge mappings
- Supervisors reviewing AI governance settings
- Compliance officers auditing AI decisions
What the demo covers
- Context detection from active case, lead, and alert screens
- Evidence-linked query and response workflow
- Action recommendations with approval controls
- Trust model configuration by role and action type
- AI audit log and governance dashboard
- Drive document summarization with evidence linking
Responsible AI use
AI assists investigators — it does not replace them.
AEGIS AI is a decision-support tool. AI outputs may include errors, omissions, or inaccuracies, including in summaries, similarity analyses, risk assessments, and recommended actions. Human review is required before any AI-suggested output is used to inform an investigation, payment, recovery, referral, regulatory submission, or other decision. AEGIS AI is not a substitute for investigator judgment, clinical or professional expertise, or legal counsel, and does not provide medical, legal, or professional advice. Customers are responsible for reviewing AI outputs for accuracy, completeness, fairness, and appropriate supporting evidence consistent with the Terms of Service and the applicable Business Associate Agreement.
FAQ
Common questions about AEGIS AI.
How is AEGIS AI different from ChatGPT or other AI chatbots?
Unlike general-purpose AI chatbots, AEGIS AI is purpose-built for healthcare fraud investigation. It reads your active case, lead, document, or provider context and provides answers grounded in your specific investigation data. It does not rely on general internet knowledge — every response references evidence from the case record.
What is the graduated trust model?
The graduated trust model is a 5-level system (Off, Shadow, Suggest, Confirm, Autonomous) that lets organizations control how much autonomy the AI has. Trust levels can be configured by role, action type, and tenant policy.
Can the AI make decisions without human approval?
Only at the highest trust level (Autonomous), and only for pre-approved, low-risk action types defined by organization policy. At all other trust levels, AI recommendations require explicit human review and approval.
How does AEGIS AI support HIPAA compliance?
AEGIS AI operates within the same HIPAA-aligned safeguards as the rest of the AEGIS ISD platform. AI processing respects role-based access controls, data stays within the tenant's isolated schema, and every AI interaction is logged in the audit trail.
Can AEGIS AI summarize clinical documents?
Yes. Through Drive integration, the AI produces concise or detailed document summaries with key clinical findings, risk indicators, documentation gaps, and recommended follow-up actions. Summaries are linked to source evidence for verification.