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LLM_Engineering_OLD/week5/knowledge-base/contracts/Contract with United Healthcare Alliance for Healthllm.md
Edward Donner e5c3fcab46 Updated Week 5 with November version
2025-11-04 07:26:42 -05:00

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Contract with United Healthcare Alliance for Healthllm

Contract Date: May 15, 2025 Contract Number: HL-2025-E-0156 Parties:

  • Insurellm, Inc.
  • United Healthcare Alliance, LLC

Terms

  1. Coverage: Insurellm agrees to provide United Healthcare Alliance with enterprise access to the Healthllm platform, including extensive customization, multi-state support, dedicated infrastructure, and premium support services for their nationwide health insurance operations covering 250,000+ members across 12 states.

  2. Duration: This agreement is effective for a period of 48 months from the contract date, representing Insurellm's most strategic long-term healthcare partnership.

  3. Payment: United Healthcare Alliance shall pay custom Enterprise Tier pricing of $52,000 per month for months 1-12, $56,000 per month for months 13-24, $60,000 per month for months 25-36, and $64,000 per month for months 37-48, totaling $2,784,000 over the contract term.

  4. Service Level Agreement: Insurellm guarantees 99.95% uptime measured monthly, with financial credits: 7% monthly credit for each hour of unplanned downtime exceeding the SLA, maximum 50% monthly credit.

  5. Confidentiality: Both parties agree to maintain the highest level of confidentiality regarding AI algorithms, predictive models, member PHI, provider contracts, and strategic initiatives.

  6. Security and Compliance: Insurellm commits to maintaining HIPAA compliance, HITRUST certification, SOC 2 Type II, and annual third-party security audits with penetration testing.

  7. Business Continuity: Guaranteed 2-hour recovery time objective (RTO) and 15-minute recovery point objective (RPO) with active-active data center configuration.

Renewal

This agreement includes a mutual 120-day renewal notice period. United Healthcare Alliance receives most-favored-customer pricing guarantees and priority access to all new features. Contract may be extended in 12 or 24-month increments with mutual written agreement and will include joint planning for next-generation healthcare technology initiatives.

Features

United Healthcare Alliance will receive the complete Healthllm Enterprise suite with custom enhancements:

  1. Unlimited Member Administration: No capacity restrictions, supporting United's 250,000+ members with scalability to 1 million+ members as business expands.

  2. Multi-State Operations: Complete support for health insurance administration across all 12 states where United operates:

    • State-specific plan designs and benefit variations
    • 50-state regulatory compliance monitoring
    • Multi-state network adequacy reporting
    • State-specific form filing and rate approvals
    • Local market competitive intelligence

  3. White-Label Platform: Complete branding customization:

    • Custom domains (members.unitedhealthcarealliance.com, providers.unitedhealthcarealliance.com)
    • Branded mobile apps for iOS and Android with full UI/UX customization
    • Customized member communications and marketing materials
    • Co-branded provider portals and broker platforms

  4. Advanced AI Claims Adjudication: Enterprise-grade claims processing:

    • Auto-adjudication rate of 85%+ for clean claims
    • Real-time fraud detection with 92%+ accuracy
    • Predictive payment integrity scoring
    • Provider billing pattern analysis
    • Upcoding and unbundling detection
    • Coordination of benefits (COB) automation
    • Subrogation opportunity identification

  5. Population Health Management: Comprehensive analytics for value-based care:

    • Real-time risk stratification across entire member population
    • Chronic disease identification and progression modeling
    • Predictive analytics for 30+ conditions
    • Hospital readmission prevention protocols
    • Care gap analysis for HEDIS and STAR measures
    • Social determinants of health (SDOH) integration
    • Health equity analytics and disparity identification

  6. Complete API Access: Unlimited API calls supporting:

    • Real-time integration with United's core systems
    • Provider portal and directory synchronization
    • Claims clearinghouse EDI transactions (837, 835, 834, 270/271)
    • Pharmacy benefit manager (PBM) integration
    • Health Information Exchange (HIE) connectivity
    • Data warehouse bidirectional sync
    • Third-party vendor integrations (lab systems, imaging centers, etc.)

  7. Advanced Provider Network Management:

    • Credentialing and re-credentialing for 15,000+ providers
    • Contract management with version control and approval workflows
    • Provider performance scorecards and tiering
    • Network adequacy modeling and gap analysis
    • Cost and quality analytics by provider
    • Center of Excellence (COE) program management
    • Value-based payment arrangement tracking

  8. Comprehensive Medication Management:

    • Multi-tier formulary management (national and state-specific)
    • Prior authorization with clinical decision support
    • Step therapy and quantity limit enforcement
    • Specialty pharmacy program management
    • Biosimilar and generic substitution optimization
    • Medication adherence prediction and intervention
    • Drug spend forecasting and budgeting
    • Manufacturer rebate tracking and optimization

  9. Member Engagement Suite:

    • Omnichannel communication platform (SMS, email, push, voice)
    • Personalized member portal with AI-powered chatbot
    • Telehealth platform integration (video visits, e-consults)
    • Preventive care reminder campaigns
    • Wellness program platform with incentives and gamification
    • Member satisfaction surveying and feedback analysis
    • Health literacy tools and educational content

  10. Quality and Performance Management:

    • HEDIS measure calculation and reporting
    • STAR ratings optimization for Medicare Advantage
    • CAHPS survey administration and analysis
    • Quality improvement initiative tracking
    • Provider pay-for-performance administration
    • Shared savings calculation for ACO programs
    • Risk adjustment and HCC coding validation

  11. Advanced Analytics and Business Intelligence:

    • Real-time operational dashboards for all user roles
    • Executive dashboards with KPIs and trend analysis
    • Predictive modeling for medical cost trends
    • Member churn and retention analysis
    • Market share and competitive positioning reports
    • Financial forecasting and budget variance analysis
    • Custom analytics with embedded data science team support

  12. Regulatory Compliance and Reporting:

    • ACA compliance monitoring (MLR, essential health benefits, preventive services)
    • Multi-state regulatory filing management
    • CMS reporting for Medicare Advantage products
    • State insurance department examinations support
    • HIPAA privacy and security compliance with audit trails
    • Fraud, waste, and abuse (FWA) detection and reporting
    • Annual compliance certification and attestation

Support

Insurellm commits to comprehensive Enterprise-level support for United Healthcare Alliance:

  1. Dedicated Success Team:

    • Executive sponsor (CEO-level) with monthly strategic reviews
    • Dedicated Vice President of Customer Success with weekly engagement
    • Senior Technical Account Manager for system optimization
    • Solutions Architect team for ongoing innovation (2 FTE)
    • Data Science team for advanced analytics projects (1.5 FTE)
    • Quarterly executive business reviews with C-suite from both companies

  2. 24/7/365 Premium Support:

    • Guaranteed 10-minute response for P1 critical issues
    • 30-minute response for P2 high-priority issues
    • 2-hour response for P3 standard issues
    • Dedicated support team of 8+ specialists familiar with United's environment
    • Private war room for incident management
    • Dedicated Slack and Microsoft Teams channels with engineering access
    • Quarterly on-site support visits (minimum 8 per year)

  3. Comprehensive Implementation:

    • 18-month phased implementation program with 4 major go-live events
    • Dedicated program management office (PMO) with weekly steering committee
    • Migration of 250,000+ member records from legacy systems
    • Integration with 15,000+ provider records and credentialing data
    • Training for 300+ United staff across all departments
    • Training for 100+ key provider practices and health systems
    • Parallel processing with legacy system for 120 days
    • Go-live support with 12-week on-site Insurellm team presence (6-10 people)

  4. Training and Enablement:

    • Comprehensive role-based training programs for all staff
    • Executive leadership training on healthcare AI and analytics
    • Train-the-trainer certification for United's L&D team
    • Annual user conference attendance (10 attendees, all expenses paid)
    • Monthly advanced training sessions on new features
    • Unlimited online learning platform access with 200+ courses
    • Custom training content development for United-specific processes
    • Clinical training for care management and utilization review staff

  5. Custom Development:

    • 3,000 hours annually of custom development included
    • Dedicated development team (4 developers, 1 PM, 1 QA) for United-specific features
    • Priority feature requests with guaranteed product roadmap inclusion
    • Beta access to all new features 120 days before general release
    • Joint innovation projects and co-development opportunities
    • Input into 5-year product strategy and roadmap
    • Potential for United to influence industry direction through partnership

  6. Integration Services:

    • Enterprise integration with United's complex system landscape:
      • HealthEdge iBridge policy administration
      • Epic care management system integration
      • Salesforce Health Cloud CRM
      • Multiple PBMs (CVS Caremark, Express Scripts)
      • Availity and Change Healthcare clearinghouses
      • Truven Health Analytics
      • Provider credentialing systems (CAQH ProView)
      • NCQA HEDIS reporting systems
      • Financial systems (Oracle ERP, Workday)
      • Data lake on Snowflake and AWS
    • Dedicated integration team (2 FTE integration engineers)
    • Monthly integration health assessments with optimization
    • Performance tuning and load testing before peak periods (open enrollment)

  7. Analytics and Reporting:

    • Custom dashboard development (unlimited)
    • Real-time operational dashboards for claims, enrollment, utilization
    • Executive dashboards with drill-down capabilities
    • Automated reporting suite (daily, weekly, monthly, quarterly, annual)
    • Ad-hoc analytics support (unlimited requests with 48-hour SLA)
    • Industry benchmarking against top 100 health plans
    • Predictive modeling consultation (bi-weekly sessions)
    • Embedded data science team for advanced projects
    • Access to Insurellm's proprietary healthcare benchmarking database

  8. Compliance and Regulatory Support:

    • Monthly compliance reviews with detailed documentation
    • Annual HIPAA security risk assessment with remediation planning
    • Annual HITRUST assessment support
    • ACA reporting (1094/1095 forms, MLR calculations, essential health benefits)
    • Medicare Advantage CMS reporting support
    • Multi-state regulatory filing coordination
    • Quality measure calculation (HEDIS, STAR, CAHPS)
    • External audit support (state exams, CMS audits, accreditation)
    • Fraud, waste, and abuse program support

  9. Continuous Improvement:

    • Bi-weekly process optimization workshops
    • Quarterly efficiency audits with detailed ROI analysis
    • Best practice sharing from across Insurellm's customer base
    • Innovation lab partnership for emerging technologies:
      • AI and machine learning advancements
      • Blockchain for claims and credentialing
      • Natural language processing for clinical documentation
      • Predictive analytics for population health
    • Joint whitepapers and case studies for industry publication
    • Speaking opportunities at major industry conferences (AHIP, HIMSS)
    • Collaboration on thought leadership and regulatory advocacy

Signatures:

Jennifer Rodriguez Title: Chief Executive Officer Insurellm, Inc. Date: May 15, 2025

James Patterson Title: Chairman & Chief Executive Officer United Healthcare Alliance, LLC Date: May 15, 2025

This agreement establishes United Healthcare Alliance as Insurellm's flagship enterprise health insurance partner, representing the most comprehensive strategic partnership in Insurellm's history. This partnership will drive innovation in healthcare technology and set new standards for AI-powered health insurance operations. This contract supersedes all prior agreements and communications.

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