Benefit Integrity at Government Scale

Can You Trust the Evidence Behind Your Eligibility Decisions?

Infocap combines tungsten Automation TotalAgility with AWS AI services to deliver a secure, auditable, and scalable Benefit Integrity platform so agencies can process faster, verify deeper, and protect program funds with confidence.

Request a Briefing

Designed For

Medicaid & CHIP

CMS & HealthCare.gov

Medicare

TRICARE & Military Health

State Eligibility Systems

MMIS Platforms

The Benefit Integrity Imperative

Six Questions Every Eligibility Determination Must Answer

Benefit integrity is more than fraud detection. It demands an end-to-end operating model that ensures every decision is grounded in complete, authentic, accurate, timely, and auditable evidence.

Question 1

Is the applicant, beneficiary, dependent, provider, or representative who they claim to be?

Question 2

Are the submitted documents authentic, current, complete, and unaltered?

Question 3

Does the evidence support the eligibility factors required by policy?

Question 4

Do the extracted facts match trusted internal and external data sources?

Question 5

Were exceptions, inconsistencies, and risk indicators routed to the right reviewer?

Question 6

Can the agency prove, during an audit or appeal, exactly what evidence was used and how the determination was reached?

Orchestration Layer

Tungsten Automation TotalAgility manages intake, classification, routing, validation, exception handling, human review, work queues, audit trails, and downstream system integration.

AI Intelligence Layer

Amazon Textract, Comprehend, Rekognition, Bedrock, and Bedrock Data Automation extract, classify, enrich, analyze, and verify data from structured, semi-structured, and unstructured content.

Policy and Rules Layer

Eligibility rules, state-specific policies, redetermination logic, document requirements, and risk thresholds are configured so evidence is evaluated consistently across every case.

Human Assurance Layer

Casework and program integrity staff see prioritized exceptions, source-linked evidence, confidence indicators, and case summaries - not pages of raw documentation.

Capture Evidence from Any Channel

Documents can enter from portals, scanning operations, email, fax, batch uploads, mobile capture, APIs, existing repositories, or case management systems.

Create a Unified Eligibility Case Package

TotalAgility can organize related documents, pages, metadata, correspondence, and data elements around a person, household, case, claim, renewal, appeal, or investigation.

Classify and Separate Mixed Document Packages

A single submission may contain a driver’s license, paystub, bank statement, lease, tax document, attestation, and agency form. TotalAgility coordinates classification and separation so each item is processed using the right extraction profile and validation rules.

Orchestrate AI Services

TotalAgility can invoke AWS AI services as intelligent engines within a governed workflow, rather than treating AI as an isolated black box.

Apply Validation Rules & Confidence Thresholds

Extracted data can be checked for format, completeness, required fields, date ranges, duplicate documents, missing pages, conflicting values, and confidence levels.

Route Exceptions to the Right Human Receiver

Low-confidence results, suspicious documents, incomplete evidence, conflicting eligibility factors, or high-risk cases can be routed to caseworkers, supervisors, fraud analysts, or specialized program integrity teams.

Integrate with Systems of Record

Validated results can be posted back to eligibility systems, MMIS platforms, CMS systems, document repositories, data warehouses, dashboards, reporting tools, or audit systems.

Maintain a Defensible Audit Trail

Every document, extraction result, confidence score, reviewer action, rules evaluation, system update, and exception decision can be logged for audit, appeal, and oversight.

AMAZON TEXTRACT

Document Text, Forms, Tables & Queries

Extracts typed and handwritten text, layout elements, forms, and tables from scanned documents. Textract Queries let agencies ask natural language questions, such as "What is the applicant's gross pay?", without rigid templates.

Paystubs & W-2s
Bank statements
Identity documents
Employer letters

AMAZON COMPREHEND

Natural Language Understanding & PII Detection

Identifies entries, key phrases, income-related language, household composition references, and PII/PHI. Where Textract reads structure, Comprehend interprets meaning, adding semantic depth across letters, attestations, and case notes.

Income language
PII detection
Narrative review
Entity normalization

AMAZON REKOGNITION

Image Analysis, Face Liveness & Visual Authenticity

Supports identity proofing, liveness checks, document image quality analysis, and visual tamper detection. All outputs route to authorized reviewers (not unreviewed eligibility decisions) consistent with agency privacy and civil rights governance.

Identity proofing
Liveness checks
Tamper signals
Image anomalies

AMAZON BEDROCK DATA AUTOMATION

Generative AI Multimodal Extraction & Classification

Handles the full spectrum of real-world submissions: combined PDFs, smartphone images, handwritten notes, screenshots, and documents with inconsistent layouts. Blueprint-driven extraction supports both high-volume standard documents and unusual program-specific evidence.

Package splitting
Context extraction
Unstructured docs
Custom blueprints

INFOCAP TRUST

Tamper Recognition Using Smart Technology

Extracting what a document says is not the same and knowing whether it can be trusted. Forged paystubs still contain readable text. Modified ITs still pass basic OCR Infocap TRUST moves agencies from extraction to authentication.

TRUST is an AI/ML-powered fraudulent document detection platform built for government and military healthcare environments - covering real-time authentication, tamper detection, multi-layer identity verification, and audit-ready reporting.

Hologram & watermark detection

Metadata analysis

Visual tamper patterns

Cross-document identity checks

MMIS & eligibility integration

Detect suspicious modifications before enrollment, renewal, access, or payment decisions are made.
Flag inconsistent metadata, altered photos, fake visual security features, and mismatched identities.
All authenticity signals route to authorized human review, never to unreviewed eligibility outcomes.
Purpose-built for government and military healthcare environments with full audit trail support.
Integrates into claims, enrollment, and eligibility systems as modular verification layer.

end-to-end workflow

The Full Evidence Lifecycle, Governed at Every Step

From the moment a document enters the system to the final posted determination and audit package, Infocap orchestrates every action with accountability and traceability built in.

1) Intake & Capture

Documents enter from portals, scan operations, email, fax, mobile uploads, APIs, or existing CMS and eligibility platforms. TotalAgility creates a transaction, case, renewal, claim, or investigation record and attaches all incoming evidence.

2) Document Package Splitting & Classification

BDA, Textract, and TotalAgility classify submitted documents and split combined packages into logical units. A single PDF may yield separate evidence objects: paystub, ID, lease, employer letter, bank statement, and proof of citizenship.

3) Context-Aware Extraction

Textract extracts typed and handwritten text, tables, forms, and layout. BDA applies blueprint-driven extraction for complex or unstructured documents. Comprehend enriches output by identifying entities, PII, and relevant language — all mapped to program-specific eligibility fields.

4) Document Authenticity & Identity Checks

Rekognition and Infocap TRUST evaluate visual and identity-related signals: image quality, face and liveness checks where authorized, metadata concerns, visual tamper patterns, and cross-document inconsistencies. High-risk signals are immediately routed for human review.

5) Data Normalization & Cross-Document Matching

Extracted values are normalized and compared across the full evidence package: Does the name on the ID match the application? Do paystub dates fall within the required eligibility period? Is income consistent across paystubs, bank deposits, and external data? Has the same document appeared in another case?

6) Eligibility Rules & Authoritative Source Validation

TotalAgility orchestrates rule checks and integrations with authoritative systems. Infocap MPVaaS supports real-time and batch eligibility verification, direct Federal Data Services Hub integration, automated income and employment verification, and state-specific rules execution.

7) Confidence Scoring & Risk-Based Routing

Every extraction, match, verification, and authenticity signal carries a confidence score or risk indicator. High-confidence, complete, non-conflicting evidence moves forward quickly. Low-confidence, incomplete, inconsistent, or suspicious evidence routes to the right reviewer — with a clear reason.

8) Human-in-the-Loop Review

Caseworkers and program integrity staff review only the cases requiring judgment. They see the extracted field, the source document page, the confidence score, the exception reason, and the relevant policy context. AI reduces manual burden; humans retain accountability.

9) Posting, Archiving & Audit Documentation

Validated data and decisions post back to eligibility, CMS, MMIS, claims, or case management systems. The complete evidence package — extraction results, AI outputs, rules applied, reviewer actions, timestamps, and determinations — is preserved for audit, appeal, oversight, and continuous improvement.

Medicaid & CHIP Eligibility

Automatically separates renewal packets into document types, extracts income and household evidence, verifies eligibility periods, detects cross-document discrepancies, and routes exceptions — directly addressing CMS documentation requirements for improper payment reduction.

HealthCare.gov & Marketplace

Validates identity, income, household composition, lawful presence, and eligibility periods. Automates intake and classification, detects mismatches, and generates complete audit packages showing what was submitted, extracted, verified, and approved.

Medicare Verification

Supports evidence-based verification for Medicare eligibility and enrollment workflows, with automated extraction, cross-source matching, and governed exception routing for program integrity compliance.

Military & Government Healthcare

Infocap TRUST is purpose-built for TRICARE, DoD healthcare, VA-related workflows, and government employee and dependent benefit programs — authenticating IDs, dependent cards, military documents, and medical eligibility records before access decisions are made.

Appeals, Audits & Quality Control

Reconstruct what happened in any case without searching across siloed systems. Infocap's persistent evidence trail — original documents, extracted values, source page references, rules evaluated, reviewer actions, and final disposition — makes oversight inquiries fast and defensible.

State Eligibility Modernization

Deploy as a modular layer around existing systems rather than waiting for a full core replacement. Infocap integrates with existing eligibility platforms, MMIS, data sources, repositories, and FDSH — improving verification accuracy without rearchitecting what already works.

80 – 90%

reduction in manual processing time

Earlier

fraud and tamper detection before payment

Stronger

audit readiness with complete evidence trails

Faster

determinations for legitimate beneficiaries

Lower

improper payment exposure with verified evidence

Scalable

modernization without full system replacement

governance model

AI That Supports Decisions Without Replacing Accountability

Benefit eligibility is high-stakes. Infocap's architecture treats AI as evidence automation and decision support, not as an ungoverned decision maker. Program authority remains with configured rules, policy, and authorized reviewers.

Human Accountability

AI assists with extraction, classification, summarization, comparison, and routing. Eligibility outcomes remain under program authority and authorized reviewer control.

Explainability

Every extracted value links back to the source document, page location, and confidence score so reviewers can verify the evidence behind any determination.

Confidence Thresholds

Agencies define which fields and document types require automatic acceptance, secondary validation, or mandatory human review — tailored to program risk tolerance.

Prompt & Blueprint Governance

BDA blueprints, extraction prompts, model versions, and validation rules are versioned, tested, and controlled so changes are deliberate and auditable.

Exception Transparency

Every routed exception includes a clear reason: missing document, expired ID, low confidence, mismatched name, inconsistent income, duplicate submission, or tamper signal.

Privacy & Security

PII and PHI are protected through AES-256 encryption at rest, TLS/SSL in transit, FIPS 140-2 validated modules, role-based access, redaction, and secure storage — meeting NIST 800-171 and FISMA requirements.

Ready to Strengthen Your Program Integrity Operations?

Let's discuss your document types, verification challenges, compliance requirements, and how Infocap's Benefit Integrity model fits your mission.