MOC Fiduciary Intelligence offers an AI‑driven service that ingests a self‑insured health plan’s documents and claims data, scores the plan against 32 fiduciary indicators, and quantifies waste by identifying specific dollar gaps. The platform reviews 100% of claims, delivering a single fiduciary score (1‑10) and a detailed report that ties each finding to contract terms, enabling employers to recover millions in unnecessary spending.
Funding
Funding not disclosed
Founders
Product
Problem
Self‑insured health plans often lack the tools to systematically compare contract terms with actual claim payments, leading to hidden fiduciary breaches and millions of dollars in waste such as PBM spread pricing, duplicate facility fees, and out‑of‑network leakage.
Solution
MOC Fiduciary Intelligence provides an AI‑driven platform that ingests a year of de‑identified claims, census data, and plan documents, then evaluates the plan against 32 ERISA and CAA fiduciary indicators. The system generates a single fiduciary score (1‑10) and a detailed report that quantifies each identified gap in dollar terms, linking findings directly to specific contract provisions or benchmarks. By reviewing 100% of claims, the platform uncovers waste opportunities that traditional audits miss, enabling plan sponsors to recover exact dollar amounts and mitigate fiduciary risk.
Target Audience
Primary customers are self‑insured employers, health plan administrators, and third‑party administrators responsible for fiduciary compliance and cost containment.
Features
- AI agent reads and cross‑references all plan documents, contracts, and 12 months of de‑identified claims data
- Automated scoring against 32 fiduciary indicators aligned with ERISA and CAA standards
- Line‑by‑line comparison of actual payments to contract terms, Medicare rates, and regional benchmarks
- Quantified waste identification for PBM spread pricing, duplicate facility fees, generic substitution gaps, and out‑of‑network leakage
- Comprehensive report linking each dollar‑level finding to the relevant contract provision for actionable remediation
- Full claim coverage (100% of claims) versus traditional audit sampling