Back to playbooks

AI Claims Governance

This package is for the institutional side of claims and eligibility systems: action thresholds, ownership, procurement terms, auditability, and the minimum floor for adverse decisions in low-exit systems.

Use it when the question is what agencies, payers, buyers, oversight bodies, or advocates should require before AI-assisted denial systems are treated as legitimate.

Folder map

• Human Command for Adverse Decisions
• Check the Facts Before a Denial
• Vendor Accountability and Decision Ownership
• Audit Log Specification
• Procurement Contract Rider
• Quarterly Denial Integrity Review

Use this package for

• procurement and vendor controls
• action thresholds before adverse determinations
• assigned decision ownership
• audit rights and records standards
• recurring oversight and integrity review

Back to playbooks