Carrier Systems · API Infrastructure

Carrier Infrastructure.

Connect your plan data, formulary, and enrollment systems to every distribution channel simultaneously. AI-native APIs built for the complexity of Medicare Advantage carrier operations.

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Medicare Advantage Market · $600B+ 33M+ Beneficiaries Enrolled Commission Flow · $18B Annually D-SNP Enrollment Growing 22% YoY 2,400+ Brokers Served CMS 2027 Rate Notice · Released FMO Technology Gap · 15 Years AI-Native Infrastructure · Now Available April 2026 · 50% Upfront Pricing Medicare Advantage Market · $600B+ 33M+ Beneficiaries Enrolled Commission Flow · $18B Annually D-SNP Enrollment Growing 22% YoY 2,400+ Brokers Served CMS 2027 Rate Notice · Released FMO Technology Gap · 15 Years AI-Native Infrastructure · Now Available April 2026 · 50% Upfront Pricing
Core Capabilities

Six API layers.
One integration.

Every critical carrier data system connected to your distribution network through a single AI-native interface.

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Plan Data APIs
Real-time plan benefit data, service area, and premium feeds synchronized across all distribution channels. Millisecond latency with 99.99% uptime SLA.
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Formulary Management
Dynamic drug formulary APIs with tier classification, prior authorization requirements, and quantity limits. Updated daily in sync with CMS formulary submissions.
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Enrollment Processing
Direct enrollment submission and status tracking with CMS MARx integration. End-to-end enrollment lifecycle from application to confirmation in real time.
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Member Analytics
Post-enrollment member behavior analytics, retention scoring, and disenrollment prediction. Identify at-risk members before they submit a DSNP disenrollment request.
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Distribution Intelligence
Channel attribution, broker performance data, and commission flow analytics from the carrier perspective. Full visibility into every distribution partner.
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Compliance Monitoring
CMS audit readiness, HIPAA compliance tracking, and regulatory reporting automation. Continuous monitoring with real-time alerts for compliance drift.
Integration Architecture

Connected to every
system in the chain.

Carrier Systems plugs into existing CMS infrastructure, clearinghouses, broker portals, and FMO platforms — no rip-and-replace required.

Data Flow 01
CMS → Carrier → Distribution
CMS regulatory data, rate notices, and plan approval statuses are ingested, normalized, and pushed downstream to every distribution channel simultaneously. No manual intermediary step.
Data Flow 02
Enrollment → MARx → Confirmation
Applications submitted through broker portals or direct enrollment routes pass through our validation layer before CMS MARx submission, reducing rejection rates and processing time.
Data Flow 03
Member Data → Analytics → Action
Post-enrollment member interactions feed the analytics engine continuously. Retention models update nightly. Distribution teams receive intervention alerts before disenrollment windows open.
Connected Systems
CMS MARx EDI 834/835 HPMS PBM APIs SBM / FFM SFTP Clearinghouse FHIR R4 Salesforce Health Cloud Sunfire Matrix Connecture GoHealth SelectQuote API
Use Cases

Built for every
stakeholder in the chain.

Carrier Systems delivers distinct value to health plans, distribution partners, and compliance teams — all from one integration layer.

For Health Plans
Manage Distribution at Scale
Health plans gain real-time visibility into every distribution channel — broker, FMO, direct, and telesales — from a single analytics surface. Commission flows, enrollment volumes, and channel performance tracked at the plan level.
  • 01 Plan data publishing — push benefit changes to all channels instantly
  • 02 Channel attribution — know exactly which distribution source drives enrollment
For Brokers & FMOs
Real-Time Plan Data Access
Brokers and FMOs consuming the Carrier Systems API get live plan data, formulary lookups, and service area validation in milliseconds. Present accurate information to beneficiaries at the moment of sale — every time.
  • 01 Live formulary lookup — real-time drug coverage verification at point of sale
  • 02 Enrollment status — track submission through CMS confirmation in real time
For Compliance Teams
Audit-Ready Data Architecture
Compliance teams get a complete, immutable audit log of every data transaction across the carrier-to-distribution chain. CMS audit requests answered in hours, not weeks. HIPAA compliance tracking built in at the infrastructure layer.
  • 01 Immutable audit trail — every data transaction logged and timestamped
  • 02 HIPAA compliance — BAA-ready infrastructure with automated PHI tracking
Ready to Connect?

Your carrier infrastructure,
rebuilt for AI.

Connect plan data, formulary, and enrollment systems to every distribution channel simultaneously. Request access to Carrier Systems today.

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