Modernize your claims and member systems without breaking them.

Hypercubic moves healthcare payers from COBOL to cloud in quarters — with line-level proofs every claims adjudication, eligibility, and payment path behaves identically, continuously audit-ready documentation for HIPAA and CMS oversight, and the expertise of your senior engineers captured before they retire.

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70%

of major health payers still process claims on mainframe systems

6B+

claims processed annually on legacy healthcare platforms in the US

Hypercubic Intervention

Challenge	Solution
Claims adjudication logic is understood by a handful of senior engineers Claims systems carry decades of coverage rules, plan configurations, Medicare and Medicaid edge cases, and state-specific mandates in COBOL. A few senior engineers know how it actually adjudicates.	HyperTwin HyperTwin observes how your senior claims and eligibility engineers actually work — benefit determination, coordination of benefits, NCCI edits — and turns each session into a queryable expert model.
HIPAA and CMS audits require documentation of every claims path HIPAA, HITECH, CMS program audits, and internal SOX controls demand traceable documentation of every code path touching PHI, benefit determination, or payment. Today manually reconstructed.	HyperDocs HyperDocs continuously generates audit-ready documentation of every claims pipeline, eligibility flow, and payment calculation — with full traceability to source COBOL. HIPAA and CMS audit prep moves from weeks to hours.
A claims modernization error hits members and regulators simultaneously Payer core replatforms that go wrong cause denied claims, member complaints, CMS inquiries, and state DOI scrutiny. The bar is provable equivalence on every adjudication and payment path.	HyperLoop HyperLoop produces line-level correctness proofs that every adjudication, eligibility, and payment path in the modernized code behaves identically to the original — so you migrate without denied claims or CMS complaints.
Nightly claims runs and remittance generation depend on shrinking operator expertise End-of-cycle claims adjudication runs, member enrollment loads, and remittance / EOB generation jobs run on z/OS schedules operated by senior engineers whose knowledge is not being replaced.	Hopper Hopper works as an AI agent on z/OS — navigating ISPF, submitting JCL, monitoring JES, and triaging incidents with SMF and RACF data. Nightly failures get resolved before they delay a claims or EOB cycle.

Challenge

Solution

Claims adjudication logic is understood by a handful of senior engineers

Claims systems carry decades of coverage rules, plan configurations, Medicare and Medicaid edge cases, and state-specific mandates in COBOL. A few senior engineers know how it actually adjudicates.

HyperTwin

HyperTwin observes how your senior claims and eligibility engineers actually work — benefit determination, coordination of benefits, NCCI edits — and turns each session into a queryable expert model.

HIPAA and CMS audits require documentation of every claims path

HIPAA, HITECH, CMS program audits, and internal SOX controls demand traceable documentation of every code path touching PHI, benefit determination, or payment. Today manually reconstructed.

HyperDocs

HyperDocs continuously generates audit-ready documentation of every claims pipeline, eligibility flow, and payment calculation — with full traceability to source COBOL. HIPAA and CMS audit prep moves from weeks to hours.

A claims modernization error hits members and regulators simultaneously

Payer core replatforms that go wrong cause denied claims, member complaints, CMS inquiries, and state DOI scrutiny. The bar is provable equivalence on every adjudication and payment path.

HyperLoop

HyperLoop produces line-level correctness proofs that every adjudication, eligibility, and payment path in the modernized code behaves identically to the original — so you migrate without denied claims or CMS complaints.

Nightly claims runs and remittance generation depend on shrinking operator expertise

End-of-cycle claims adjudication runs, member enrollment loads, and remittance / EOB generation jobs run on z/OS schedules operated by senior engineers whose knowledge is not being replaced.

Hopper

Hopper works as an AI agent on z/OS — navigating ISPF, submitting JCL, monitoring JES, and triaging incidents with SMF and RACF data. Nightly failures get resolved before they delay a claims or EOB cycle.

Built for the systems that actually process claims.

Mainframe runtime

COBOLJCLCICSIMSDB2VSAMAssemblerz/OS

Payer platforms

TriZetto QNXT / FacetsHealthEdgeOracle Health InsurancePlexisEXLIn-house

Compliance & regulatory

HIPAAHITECHHITRUSTCMS (Medicare / Medicaid)SOXState DOI filings

Measurable Impact

60%

Faster claims-platform modernization discovery

Claims platform re-engineering initiatives eliminate months of manual reverse-engineering by starting with an automated inventory of adjudication rules, pricing logic, COB determinations, and payer-specific processing paths across the COBOL claims estate.

Faster claims engineer onboarding

New engineers become productive on claims, enrollment, and EDI codebases faster, using HyperTwin for on-demand answers about adjudication logic and eligibility rules instead of waiting for senior SME availability.

90%

Faster HIPAA and CMS audit impact analysis

Compliance teams generate documentation for EDI transaction processing, claims data handling, and member eligibility workflows faster, with traceability from regulatory requirements to the COBOL programs and batch jobs that enforce them.

Common Questions

How does Hypercubic handle PHI and HIPAA requirements?

Hypercubic works with source code and system logic, not patient data. We do not require access to PHI. Our platform deploys within your infrastructure under strict security controls.

Can this help with our core admin system replacement?

Core admin replacements are the most complex IT projects in health insurance. Hypercubic provides a complete catalog of every adjudication rule, benefit configuration, and integration point—the critical knowledge your implementation team needs.

What about CMS regulatory changes?

When CMS mandates changes, understanding how current rules are implemented is essential for accurate updates. Hypercubic provides immediate visibility into where regulatory logic lives in your codebase, accelerating compliance timelines.

How does this support interoperability mandates?

Interoperability requires understanding what data you have, where it lives, and how it is transformed. Hypercubic provides this complete data landscape view, enabling faster implementation of FHIR APIs and data exchange requirements.

See how Hypercubic understands your claims and enrollment systems

Schedule a technical assessment with our team. We will analyze a sample of your claims adjudication or enrollment processing codebase and show you exactly how Hypercubic maps adjudication rules, eligibility logic, and EDI compliance flows.

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