Enterprise Business Capability Heatmap
Synthesized from VantageMap and LeanIX 2D matrix standards. Maps core business capabilities across healthcare domains, highlighting operational health seals, direct software cost intensity, and autonomous AI agent augmentation.
Patient & Member Engagement
Lead: Sarah Jenkins (CMO)
Omni-Channel Member Intake
Inbound member lead capture, web forms, and patient onboarding journeys.
Patient Self-Service Access
Authenticated web and mobile portal for appointment scheduling and records.
Clinical Care Delivery & EHR
Lead: Dr. Alistair Finch (CMO)
Clinical Encounter & Data Management
EHR data ingestion, FHIR v4.3 observation storage, and clinical note parsing.
Clinical Guideline & Contraindication Match
Cross-referencing MCG guidelines against patient chart history.
Revenue Cycle & Claims Administration
Lead: Marcus Vance (VP Claims)
Claims Adjudication & Prior Authorization
Pre-service medical necessity evaluation and EDI 837 claim approval scoring.
Automated Prior-Auth NLP Scoring
Autonomous extraction of clinical notes and confidence score evaluation.
X12 278 / 837 Clearinghouse Dispatch
Direct EDI settlement broadcast with national healthcare payer clearinghouses.
Enterprise Core & Corporate RevOps
Lead: Elena Rostova (Lead Architect)
Healthcare Provider Relationship Management
Enterprise contract terms, hospital network affiliations, and provider credentialing.
Regulatory Audit & PHI Governance
SOC2, HIPAA, and HITRUST compliance logging and ADR governance ledger.