Automation and AI.
Our Automation and AI services revolutionize operations for insurance companies and government agencies, improving efficiency and reducing costs.
AI Enablement
Empowering Health Plans with AI-Driven Efficiency and Governance
Mizzeto helps health plans govern AI models, mitigate risk, and meet regulatory expectations—before they become requirements.
As health plans deploy AI across claims, utilization management, and member services, they face growing risks—unaudited vendor models, missing HIPAA safeguards, unclear ownership of AI outputs, and no framework to meet CMS, OCR, or FTC expectations.
Without proper governance, even well-intended automation can trigger compliance failures and security gaps. That’s where we come in.
Health plans often can’t explain how AI decisions are made—especially with third-party tools.
There’s no single owner for AI risk, leaving compliance gaps and audit vulnerabilities.
External AI tools are often unvetted, undocumented, and operating without proper oversight.
CMS, OCR, and FTC are demanding transparency—but most plans aren't ready to respond.
From foundational policies to real-time oversight, we help you stand up governance that’s audit-ready, risk-aligned, and built to scale with your AI adoption.
Risk Frameworks: Establish payer-specific AI policies, ethical use standards, and risk tiers based on data sensitivity, business impact, and regulatory exposure.
Use Case Intake: Centralize how AI use cases are captured, assessed, and tracked—ensuring visibility across both internal tools and vendor solutions.
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Security Controls: Conduct targeted AI risk assessments, including penetration testing and DLP planning, to safeguard PHI and prevent unauthorized use.
Vendor Oversight: Automate vendor AI evaluations, embed risk flags into procurement workflows, and enforce legal and compliance review before approval.
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Operational Oversight: Deploy dashboards, audit logs, and alerts to monitor how AI is used, detect anomalies, and maintain governance over time.
Awareness & Training: Provide teams with internal guidance, responsible use resources, and communication channels for AI-related questions and escalations.
Talk to ExpertsFor Mizzeto, robust AI governance is paramount to ensure ethical and secure deployment of solutions that enhance healthcare operations
Implementing robust encryption, access controls, and anonymization techniques to protect patient data, ensuring compliance with regulations like HIPAA and GDPR while maintaining the highest standards of confidentiality.
Payers must develop AI models with interpretable algorithms, clear documentation, and visualizations to help healthcare providers and patients understand how decisions are made, fostering trust and clarity.
It's important to establish a comprehensive compliance framework that includes regular audits, adherence to healthcare standards, and collaboration with regulatory bodies to ensure AI systems meet all required regulations and guidelines.
Create clear protocols for monitoring AI performance, set up a system for reporting and addressing errors, and define the responsibilities and liabilities of all stakeholders involved to ensure AI technologies are used responsibly and effectively in healthcare.
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