Insurance-grade primary care benefitorchestration

A governed control plane for diagnostics and primary care benefits — designed to work alongside insurer policy, claims, and TPA systems.

  • Policy-aligned eligibility & entitlements
  • SLA governance across the provider network
  • Regulator-ready audit trails and reconciliation reporting
SOC 2 Type II•ISO 27001•India-based data hosting
Control Plane
Ready
1
Eligibility
2
Routing
3
SLA
4
Exceptions
5
Audit
6
Reconciliation
Orchestration Control Plane
Policy-aligned

Why insurers use DxStack

Operational challenges in distributing and managing primary care benefits at scale.

Common challenges

High ops overhead for low-ticket primary care benefits

Managing diagnostics and health checks is operationally heavy relative to transaction value.

Leakage and misuse due to weak entitlement enforcement

Without policy-grade controls, benefit misuse and leakage undermine program economics.

Inconsistent SLAs across provider network

Provider performance varies unpredictably without centralized orchestration and monitoring.

Limited visibility into fulfillment and settlement

Delayed reconciliation and incomplete audit trails complicate finance, compliance, and external regulatory audits.

What DxStack delivers

Centralized orchestration without replacing core systems

DxStack sits between insurer infrastructure and providers—no rip-and-replace.

Policy-grade entitlement controls

Enforce eligibility rules aligned with policy terms and regulatory requirements.

Governed SLA and exception workflows

Track provider commitments and handle exceptions with audit-ready escalation paths.

Regulator-ready audit and reconciliation views

Produce evidence packages for regulatory audits, with complete fulfillment and settlement visibility.

Designed to work with insurer systems

DxStack integrates alongside existing infrastructure—no core system replacement required.

DxStack does not replace

Policy administration systems
Claims engines
TPAs
Core finance systems

What DxStack does

  • Orchestrates eligibility checks against policy rules
  • Routes requests to providers based on network, geography, and contract terms
  • Governs SLAs and exception handling workflows
  • Produces regulator-ready audit trails and reconciliation data aligned with compliance requirements

API-first integration with event/webhook support for real-time data exchange.

How it works

DxStack acts as a governed orchestration layer between insurer systems (including TPAs) and provider networks.

Insurer Systems & TPAs
Policy Admin
Claims Engine
TPAs
Finance Systems
DxStack Control Plane
Eligibility checks
Provider routing
SLA monitoring
Exception handling
Provider Network
Diagnostic Labs
Health Check Centers
Home Collection

Non-invasive API-first integration — clear system boundaries and data contracts

Operational primitives

Core capabilities designed for insurance-grade benefit orchestration.

Eligibility & entitlement rules

Policy-aligned enforcement of coverage terms, eligibility criteria, and benefit limits.

Provider routing

Network-aware and geography-based routing to contracted providers.

SLA orchestration

Track provider commitments with automated monitoring and escalation workflows.

Exception handling

Governed workflows for failures, escalations, overrides, and manual interventions.

Audit logs & MIS

Complete audit trails for regulatory audits, evidence packages, and data retention compliance.

Reconciliation & settlement visibility

Real-time transparency into fulfillment status, settlement data, and finance reconciliation.

Expected outcomes

Measurable improvements from governed benefit orchestration.

SLA escalations

Reduce SLA violations and escalations via governed provider orchestration

Reconciliation backlog

Lower reconciliation discrepancies with real-time settlement visibility

Operational exceptions

Fewer manual interventions through automated exception handling workflows

Audit preparation

Audit-ready evidence packages with reduced manual documentation effort

Example insurer workflows

How DxStack orchestrates primary care benefits from eligibility to reconciliation.

Policy-covered annual diagnostics benefit

1
Eligibility check against policy terms
2
Route to network provider by geography
3
Monitor SLA for sample collection and reporting
4
Handle exceptions (re-collection, delays)
5
Generate audit trail for regulatory compliance
6
Produce reconciliation data with evidence packaging

Employer-sponsored primary care add-on

1
Verify entitlement under employer add-on policy
2
Route to preferred provider by location
3
Track fulfillment SLA and escalate if needed
4
Log exceptions and override approvals with audit trail
5
Deliver MIS for employer, insurer, and regulator reporting
6
Reconcile settlement with full evidence retention

Trust & compliance

Security and compliance posture designed for insurance and regulatory scrutiny.

Data flows and storage are designed for regulatory scrutiny and data residency requirements common in insurance operations.

SOC 2 Type II

Independent audit of security, availability, and confidentiality controls.

ISO 27001

Information security management system certification.

India-based data hosting

All data hosted within India to meet regulatory and data residency requirements.

DPDP-aligned posture

Data protection and privacy practices aligned with DPDP Act requirements.

Operate primary care benefits with insurance-grade controls

Discuss integration requirements and evaluate fit for your benefit orchestration needs.

Technical evaluation · Integration scoping · No commitment required