Turning a CMS Mandate into an Enterprise Advantage with AI
Regulatory mandates are rarely viewed as opportunities.
They’re often complex, time‑bound, and resource‑intensive - especially for large health plans operating at enterprise scale. But when a Centers for Medicare & Medicaid Services (CMS) mandate required a large Blue health plan client to change how final pay amounts were calculated and stored, enGen saw a chance to apply AI in a way that delivered measurable value.
The mandate required systems to shift from storing two decimal places to five when calculating and recording certain payment amounts. While the rule change itself was straightforward, implementing it consistently across an enterprise environment introduced important scale and compliance considerations.
CMS publishes pricing with far greater precision than what typically appears on a member bill, and rounding those values too early can create discrepancies over time. Across millions of claims, those differences add up, potentially impacting provider payments, benefit calculations, and regulatory reporting.
Compliance was non‑negotiable. But the path to compliance didn’t have to follow traditional, manual approaches.
A Mandate with Enterprise‑Wide Impact
For this large Blue health plan client, meeting the CMS requirement meant changing how final pay amounts were stored across thousands of database tables and tens of thousands of code components. Much of that work lived in legacy environments that power core claims and pricing systems.
“This wasn’t a change in one place,” said Sumit Kumar, Chief Delivery Officer at enGen Global. “It touched thousands of components across the platform. Missing even a small subset could create downstream impacts or compliance risk.”
Initial estimates reflected that complexity. Using traditional approaches, completing the work manually would have taken many months – introducing risk to compliance timelines and slowing delivery of other priority initiatives.
Rather than accept that approach, enGen challenged the assumption that this was the only way forward.
“There’s a pattern to this kind of work. Once you can identify that pattern, AI becomes a powerful way to apply changes consistently and at scale.”
-Hussain Sheikh, Vice President of Product Engineering at enGen
Applying AI with Purpose
As part of its broader strategy, enGen focuses on using AI intentionally - applying it where it can deliver real efficiency, reduce waste, and improve outcomes at scale. This mandate presented a clear opportunity to put that philosophy into practice.
Working closely with enGen Global, the teams reimagined the remediation effort using AI‑enabled utilities. Rather than focusing AI on the update itself, teams applied it to orchestrating the change across interconnected systems – analyzing where updates were required and propagating them consistently at enterprise scale.
“There’s a pattern to this kind of work,” explained Hussain Sheikh, Vice President of Product Engineering at enGen. “Once you can identify that pattern, AI becomes a powerful way to apply changes consistently and at scale.”
That consistency was critical. In highly interconnected systems, a single update can cascade through dozens of downstream programs. The AI‑enabled approach accounted for those dependencies, reducing the risk of missed impacts while accelerating delivery.
“We weren’t just speeding up remediation. We were automating the work around it...so teams could move faster without sacrificing quality.”
-Hussain Sheikh
Beyond Code: Automating the Surrounding Work
enGen’s approach went beyond simply updating code faster. As changes were identified and applied, the team also automated the work that traditionally slows large remediation efforts down. Using AI, they generated technical design documentation in parallel with the code changes themselves and created test cases to support validation and regulatory rigor.
“We weren’t just speeding up remediation,” Hussain said. “We were automating the work around it - documentation, design, testing - so teams could move faster without sacrificing quality.”
The result was a more complete, end‑to‑end solution designed to support both immediate compliance needs and long‑term maintainability.
“You don't declare success until it's production-ready. What matters is delivering a solution that's tested, documented, and ready to support the mandate end to end.”
-Sumit Kumar, Chief Delivery Officer at enGen Global
Measurable Value at a Fraction of the Cost
The impact of the AI‑enabled approach was both immediate and measurable.
By applying AI to manage the scope and consistency of the change, enGen significantly accelerated delivery – meeting compliance requirements while freeing teams to stay focused on higher value work.
“Yes, there were cost savings,” Hussain noted. “But just as important, we ensured our engineers were spending their time building capabilities that move the organization forward.”
While the solution has already demonstrated significant value, it is currently completing final validation and testing, with deployment targeted later this year.
“You don’t declare success until it’s production‑ready,” Kumar said. “What matters is delivering a solution that’s tested, documented, and ready to support the mandate end to end.”
A Blueprint for AI‑Driven Compliance and Modernization
The success of this initiative reflects how enGen partners with clients to tackle unavoidable, high‑stakes work in smarter ways - using AI to reduce cost, accelerate delivery, and minimize risk.
By combining deep healthcare domain expertise with practical, responsible AI application, enGen helped the large Blue health plan client transform a regulatory requirement into an opportunity to modernize how enterprise change is delivered.
“This was a one‑time solution for a specific mandate,” Hussain said, “but the approach can absolutely inform how organizations think about modernization and compliance going forward.”
As healthcare organizations continue to navigate increasing regulatory complexity, enGen’s work demonstrates what’s possible when AI is applied with intention - turning mandates into momentum and compliance into competitive advantage.