Member support triage
A kolm template that answers member inquiries using only your plan's approved language, routes to a human agent below 0.90 confidence, and never stores or transmits PHI. The voice is tunable; the routing threshold is tunable; the receipt is mandatory. Useful for chat, IVR, and email pre-triage.
Input & output spec
One inquiry per request. The triage assistant answers from your approved-language KB and routes anything outside its confidence envelope to a human queue.
input
{
"inquiry_id": "INQ_2026_088312",
"channel": "chat", // "chat" / "email" / "ivr"
"member_id": "<redacted>",
"plan": "PPO-Gold-2026",
"text": "My MRI was denied. Can I appeal?",
"locale": "en-US"
}
output
{
"response": "You can request an internal appeal within 180 days of the denial. To start, go to the Member Portal > Claims > Appeal. We will respond within 30 days for standard appeals or 72 hours for urgent.",
"route_to_human": false,
"confidence": 0.93,
"kb_refs": ["appeals-policy-v3.2"],
"intent": "appeal_question",
"redaction_count":1
}
4-ring receipt schema
Every triage response ships a receipt your compliance team can re-verify offline. The chain proves the input inquiry, the KB references used, the response + routing, and the seal.
Verify command: kolm verify --hash <receipt_hash>. Runs locally against the seal, no network required.
BAA fast-track
Health plans on a BAA see kolm production-ready in two business days. The customer-hosted bridge runs in the tenant network boundary; PHI is processed there and never crosses our infrastructure; the audit log is yours to keep.
how it works
# 1. Sign the BAA (legal-team turnaround) [ DocuSign · 48 hours typical · mutual NDA in same envelope ] # 2. Provision the bridge in your VPC $ kolm bridge install \ --provider aws \ --region us-east-1 \ --baa <baa-id> # 3. Compile this template against your approved-language KB $ kolm compile --spec member-support-triage.spec.json \ --examples ./your-approved-qa.jsonl \ --gate 0.95 \ --out triage.kolm
what we sign
- HIPAA Business Associate Agreement - HIPAA Security Rule §164.308 (admin safeguards) - HIPAA Security Rule §164.310 (physical safeguards) - HIPAA Security Rule §164.312 (technical safeguards) - Breach Notification §164.404 - Subcontractor flow-down (none — kolm holds no PHI) - Audit-log retention (6 years, your S3 bucket)
Get the template
Two ways to take this live. Self-serve with the sample artifact, or kick off a BAA conversation if you need PHI day one.
The spec is a portable JSON file. Drop it into kolm compile --spec with your anonymized seed examples to build a private .kolm tagged LicenseRef-kolm-default-1.0 by default; pass --license to tag it differently.