Predictika · State Medicaid program quotes

An AI sales agent's Medicaid Suite program quote, checked before it goes out

An AI sales agent prepares a quote for a state Medicaid program: the modules such as Claims and Financial, Provider, AI Service Authorization, the Enterprise Data Warehouse and Pharmacy Management, the hosting, the number of members, the contract term, the discount, and the annual total the quote states. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of how these choices fit together, and returns a verdict, every reason and the annual total it computed.

Scope: One Medicaid Suite program quote: modules, hosting, members, term, discount and the stated annual total. See everything this validator covers

This validator models quotes for five Medicaid modules, not just the scenarios shown below.

  • Modules — Claims and Financial, Provider, AI Service Authorization, the Enterprise Data Warehouse and Pharmacy Management, with the other modules each one needs on the same quote.
  • Hosting and term — cloud or state hosting, the module that must be cloud-hosted, and the minimum contract term of the claims system.
  • Program size — the number of members, with a review for very large and very small programs.
  • Discount and the stated total — the discount allowed, the approval above it, the limit at 20 percent, and the annual total stated on the quote, which is compared with the computed one.

Any Medicaid Suite program quote that touches these rules is in scope — not only the scenarios pictured here. Not covered: other Conduent services. The module names come from public Conduent pages; the dependencies, term limits, discount thresholds and all prices are modeled from comparable products and are not published by Conduent.

The AI sales agentBuilds the quote from the conversation with the state agency and says it is ready to send.
Predictika validatorChecks every rule at once and returns the verdict, each finding, and the computed figures.

7 scenarios in 3 groups · each group runs from the agent’s first attempt to the outcome · click one to switch

What the agent proposes

The AI sales agent says

Illustrative agent statement. The validator receives the structured request below.

Proposing agent: AI sales agent (scripted)

Before sending, the agent must call Recorded run

Predictika validator


      

        
        
        
      

      
Waiting for the call.

      
    

  

  
  

    
Where rules-based CPQ gets it wrong
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Our assessment of what a typical rules-based CPQ (product rules, price rules and validation rules, as in Salesforce CPQ) does with the same cases. It is a judgment about effort and reliability, not a claim that nothing can be built.

    
What the validator caughtTypical rules-based CPQPredictika
Modules that depend on other modulesOnly with workarounds
AI Service Authorization and Pharmacy Management need Claims and Financial, and the Enterprise Data Warehouse needs another module as its source, so adding or dropping one module changes what the others allow.		Every module is a field of one quote, and the dependencies are checked together on every call.
Hosting and term that depend on the modulesOnly with care
AI Service Authorization must be cloud-hosted and Claims and Financial needs a term of at least five years, so each needs a rule on the module.		Modules, hosting and term are fields of one quote and are checked together on every call.
Approvals that stack on top of blocksOnly with workarounds
A discount above the allowance or a very large or very small program needs a person while a discount above 20 percent stops the quote outright, and a person should see them all at once.		Blocks and approvals are all reported together, so one problem never hides another.
A stated total that must match the computed oneOnly with workarounds
The annual total adds the modules at a price per thousand members, times the members, less the discount, so a separate rule must recompute it and compare it with the stated figure.		The stated total is a field of the quote and is compared with the computed total on every call.
Every problem returned in one answerOnly with workarounds
Rules tend to fire as a step is completed, so a rep often fixes one error and meets the next.		All findings come back together, so the agent can fix them in a single pass.

  

  

    
What this validator catches: findings from its test cases
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Every rule is checked on every call, in any order the choices arrive; one problem never hides another. Blocking findings stop the quote; approval findings need a person to sign off; everything else is computed.

    
1The quote has no Conduent Medicaid Suite module.
2The AI-Powered Medicaid Service Authorization Module needs the CMdS Claims and Financial Solution on the same quote.
3Medicaid Pharmacy Management needs the CMdS Claims and Financial Solution on the same quote.
4The Enterprise Data Warehouse needs at least one other module as its data source.
5The AI-Powered Service Authorization Module is delivered in the cloud; it cannot be state-hosted.
6The Claims and Financial Solution needs a contract term of at least 5 years; the quote has 4 years.
7The quote has no enrolled members.
8A discount of 21 percent is above the 20 percent limit.
9A discount of 12 percent needs executive approval.
10The quote states $1,000 a year; the quoted modules come to $19,608,000 a year.
11A program of 3,000 thousand members needs a large-program review.
12A claims system for only 99 thousand members needs a small-program review.
13A 9-year term needs a long-term contract review.

  

  

    
Scenarios and results
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The recorded result of the validator for each scenario on this page: the request the AI agent sent, the verdict, and every finding, in the order they appear above.

    
1. AI Service Authorization quote: AI Service Authorization and Pharmacy Management without Claims and Financial, state-hosted

    
The agent's request. Please quote AI Service Authorization and Pharmacy Management, state-hosted, for 800 thousand members over 3 years, with a 12 percent discount. The quote states an annual total of $10,982,400. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Service Authorization needs Claims. The AI-Powered Medicaid Service Authorization Module needs the CMdS Claims and Financial Solution on the same quote.
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  • Pharmacy Management needs Claims. Medicaid Pharmacy Management needs the CMdS Claims and Financial Solution on the same quote.
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  • AI module is cloud only. The AI-Powered Service Authorization Module is delivered in the cloud; it cannot be state-hosted.
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  • Discount needs approval. A discount of 12 percent needs executive approval.
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2. AI Service Authorization quote: The agent resubmits after fixing the errors

    
The agent's request. Please quote Claims and Financial, AI Service Authorization and Pharmacy Management, state-hosted, for 800 thousand members over 3 years, with a 12 percent discount. The quote states an annual total of $26,188,800. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • AI module is cloud only. The AI-Powered Service Authorization Module is delivered in the cloud; it cannot be state-hosted.
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  • Claims needs a longer term. The Claims and Financial Solution needs a contract term of at least 5 years; the quote has 3 years.
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  • Discount needs approval. A discount of 12 percent needs executive approval.
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3. AI Service Authorization quote: The agent resubmits after fixing the errors

    
The agent's request. Please quote Claims and Financial, AI Service Authorization and Pharmacy Management, cloud-hosted, for 800 thousand members over 5 years, with a 8 percent discount. The quote states an annual total of $27,379,200. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Price summary. 3 module(s) at $3,100 per 1,000 members per month, 800 thousand members, $29,760,000 a year gross, 8 percent discount, $27,379,200 a year net, $136,896,000 over 5 years (illustrative prices).
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4. Data Warehouse quote: The Enterprise Data Warehouse alone, a discount above 20 percent and a total left over from an earlier draft

    
The agent's request. Please quote the Enterprise Data Warehouse, cloud-hosted, for 4,000 thousand members over 7 years, with a 22 percent discount. The quote states an annual total of $19,608,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • EDW needs another module. The Enterprise Data Warehouse needs at least one other module as its data source.
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  • Discount over the hard limit. A discount of 22 percent is above the 20 percent limit.
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  • Stated annual total does not match. The quote states $19,608,000 a year; the quoted modules come to $16,848,000 a year.
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  • Large program review. A program of 4,000 thousand members needs a large-program review.
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5. Data Warehouse quote: The agent resubmits after fixing the errors

    
The agent's request. Please quote Provider and the Enterprise Data Warehouse, cloud-hosted, for 1,500 thousand members over 7 years, with a 8 percent discount. The quote states an annual total of $13,248,000. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Price summary. 2 module(s) at $800 per 1,000 members per month, 1,500 thousand members, $14,400,000 a year gross, 8 percent discount, $13,248,000 a year net, $92,736,000 over 7 years (illustrative prices).
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6. Small program quote: A claims system for 60 thousand members on a 3-year term, with a total left over from an earlier draft

    
The agent's request. Please quote Claims and Financial and Provider, cloud-hosted, for 60 thousand members over 3 years, with a 5 percent discount. The quote states an annual total of $19,608,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Claims needs a longer term. The Claims and Financial Solution needs a contract term of at least 5 years; the quote has 3 years.
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  • Stated annual total does not match. The quote states $19,608,000 a year; the quoted modules come to $1,470,600 a year.
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  • Small program review. A claims system for only 60 thousand members needs a small-program review.
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7. Small program quote: The agent resubmits after fixing the errors

    
The agent's request. Please quote Claims and Financial and Provider, cloud-hosted, for 150 thousand members over 5 years, with a 5 percent discount. The quote states an annual total of $3,676,500. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Price summary. 2 module(s) at $2,150 per 1,000 members per month, 150 thousand members, $3,870,000 a year gross, 5 percent discount, $3,676,500 a year net, $18,382,500 over 5 years (illustrative prices).
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Narration transcript
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The text of the narrated walkthrough, step by step.

    
    
      
  1. Welcome to a demo of Predictika's Validator. An AI sales agent prepares a quote for a state Medicaid program: the modules such as Claims and Financial, Provider, AI Service Authorization, and more. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of how these choices fit together, and returns a verdict, every reason and the annual total it computed.
    2. 
      
  2. I will start with the first request by the agent.
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  3. The agent says. Please quote AI Service Authorization and Pharmacy Management, state-hosted, for 800 thousand members over 3 years, with a 12 percent discount. The quote states an annual total of $10,982,400. The rest of the request is on screen.
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  4. Before it goes out, the agent calls the validator.
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  5. Blocked, with three findings and one approval, all in one answer. The AI-Powered Medicaid Service Authorization Module needs the CMdS Claims and Financial Solution on the same quote. Medicaid Pharmacy Management needs the CMdS Claims and Financial Solution on the same quote. The AI-Powered Service Authorization Module is delivered in the cloud; it cannot be state-hosted.
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  6. The validator returned three blocking findings and one approval in one answer. A check that reads one field at a time would pass most of this; it shows only when the choices in the quote are checked against each other.
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  7. What this shows: for modules that depend on other modules, a rules-based CPQ can do this only with workarounds.
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  8. Now the agent resubmits.
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  9. The corrected request. It changes the Claims and Financial to yes and the annual total stated on the quote to $26,188,800.
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  10. It calls the validator again.
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  11. Still blocked, with two findings and one approval, all in one answer. The AI-Powered Service Authorization Module is delivered in the cloud; it cannot be state-hosted. The Claims and Financial Solution needs a contract term of at least 5 years; the quote has 3 years.
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  12. Two findings cleared. Still blocking: AI module is cloud only. Newly found: claims needs a longer term. One approval also remains for a person: discount needs approval.
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  13. The agent resubmits once more.
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  14. The revised request. It changes the hosting to cloud-hosted, the term to 5 years, the discount to 8 percent and the annual total stated on the quote to $27,379,200.
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  15. It calls the validator once more.
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  16. This time the validator clears it.
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  17. All three earlier findings are cleared.
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  18. Four problems caught in one call, fixed in two passes, and a clean $27,379,200 quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
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