Medicaid provider call center uses CoreAI for self‑service; department says tool doesn't make decisions

Scott Lindbloom, director of provider relations and operations, briefed the committee on the department’s use of a core AI platform in its provider call center under an Optum contract.

Lindbloom stressed an operational distinction: "Core AI is an AI‑enabled service interface, and it's not a Medicaid decision‑making system. It cannot approve or deny a claim. It can't change or adjust a claim. It cannot determine payment amounts, approve or deny provider enrollment, determine provider status, or make member eligibility determinations." He said the CoreAI deployment does not use generative LLMs or independently formulate policy interpretations; instead it recognizes intent, follows predefined flows, and queries the MMIS to return existing information (for example, claim status).

The department reported CoreAI handles about 2,700 automated interactions per month, compared with roughly 15,000–16,000 live provider calls. Lindbloom said Optum chose CoreAI as part of its contracted solution and that OIT reviewed and approved the security and architecture. Committee members asked about cloud residency and vendor selection; Lindbloom said the platform uses APIs to connect with the MMIS and that OIT participated in the approval process.