Member360
The planned full product is an agentic layer for navigating denied claims. It is being designed to read an Explanation of Benefits, explain the denial, identify the likely next contact, and prepare a call script and appeal path. It would explain a decision — never make one.
MRI — Right Knee · DENIED
Billed $1,250 · Member owes $1,250
Illustrative interface · sample claim data
A denial can turn into a maze of codes, documents, and phone calls.
The public preview helps people translate plan language. The full product concept goes further: make the next responsible party, supporting document, and escalation step easier to understand.
Five answers the full product is designed to provide.
The intended workflow would read an EOB, interpret the denial against the member's plan documents, and organize five practical answers for the person to verify before acting.
Why it happened
The denial code, in plain English. No CARC jargon, no guessing.
Who's responsible
Provider, plan, or you — so you call the right party first.
What to say
A call script with your claim ID, date, and provider NPI filled in.
What you owe
Deductible context and an estimated responsibility to verify.
How to appeal
The deadline, the SBC section to cite, and the escalation path.
In healthcare, a confidently wrong answer causes harm.
The product is being designed so precise parts use deterministic lookups rather than generated guesses. Plan-rule answers must point to a named section of the member's plan documents.
If a code cannot be recognized, the intended behavior is to say so and point the person to Member Services—not invent an answer.
Member360 explores how careful product design can make a complex, high-stakes, data-sensitive workflow easier to understand while keeping the final decision with the plan and the member.
Member360 is coming soon.
The full Member360 product is still coming soon. In the meantime, explore the free public preview at member360.ai.