Appeals and Grievances Case Management

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Our Appeals and Grievances Case Management Solution directly addresses these critical issues by leveraging advanced AI and automation. The solution streamlines time-intensive workflows, ensuring faster, more accurate resolution of cases while maintaining full regulatory adherence. By automating manual processes, it significantly reduces the risk of human error and mitigates costly penalties.

Inovaare Regulatory Compliance Management

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Inovaare’s Healthcare Regulatory Compliance Management is an AI-driven, cloud-native suite designed specifically for modern health plans—spanning Medicare, Medicaid, and commercial markets. It aims to simplify compliance, ensure audit readiness, and reduce regulatory risk through automation, real-time insights, and seamless integrations. Key Features & Capabilities: AI-Powered Automation Automates manual compliance tasks—such as monitoring regulatory changes, managing documentation, and updating policies—helping teams stay efficient and focused on strategic initiatives. Unified Dashboard & Real-Time Monitoring Offers a central interface to monitor compliance activities, receive proactive alerts on potential violations, access on-demand reports, and maintain a comprehensive audit trail for transparency and accountability. Robust Reporting & Analytics Delivers powerful analytics to identify trends, detect gaps, and support continuous compliance—even amid evolving regulations. Modular Product Suite: The compliance management suite includes these integrated modules: Regulatory Library – a centralized, up-to-date repository of relevant regulations Contracts Management – centralized handling of contracts to ensure compliance and mitigate risks Policies & Procedures (P&P) – governance of policy documentation and updates Issue Management – tracking and resolution of compliance issues Corrective Action Plan (CAP) – managing remediation efforts and follow-through Compliance Copilot – AI-assisted guidance to navigate and streamline compliance workflows

Healthcare Audit management

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Inovaare’s Healthcare Audit & Monitoring platform is a cloud-based solution designed to eliminate manual audit chaos. It streamlines the entire audit life cycle, from planning and execution to evidence collection and reporting, with powerful automation, real-time tracking, and AI-driven insights. Key Benefits Workflow Streamlining: Automates audit planning and execution, reducing manual burdens and boosting efficiency. Unified Management Hub: Centralizes audits, incidents, corrective actions, and reporting in a single system. Full Transparency: Maintains audit trails with real-time tracking and logs for compliance and accountability. Operational Visibility: Tracks and resolves issues proactively to reduce risk and enhance performance. Feature Highlights Comprehensive Audit Control: Manage audits, corrective actions, and incidents through a customizable, unified framework. Real-Time Monitoring: Dashboards and alerts provide continuous oversight of key metrics and risk indicators. Audit Copilot (AI-Powered Assistant): Leverages GenAI and NLP to summarize findings, detect patterns, and analyze unstructured data—significantly accelerating audit analysis. Secure & Compliant: Built with HIPAA compliance and HITRUST certification, with encryption, role-based access, audit logs, and secure hosting.

Program Audit Universe Data Management

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Inovaare’s Universe Management System (UMS) is a purpose-built, cloud-native platform designed specifically to help Medicare and Medicare Advantage health plans consistently and confidently prepare for CMS Program Audits. It combines automation, real-time monitoring, and secure delegate collaboration to ensure submissions are always CMS-compliant. Key Benefits & Value Always audit-ready — Automates the entire process, from data ingestion to compliance checks and submission-ready universe files. Complete operational oversight — Real-time dashboards highlight data gaps, aging files, and outliers across internal teams and delegated entities. Delegate-friendly workflows — Secure portals enable FDRs to scrub and submit universe files directly, reducing errors and communication chaos. Reduced audit costs and effort — Streamlines processes and lowers manual labor by providing structured, clean data workflows and submission tools. Core Features Built-In Compliance Rules Auto-updates with latest CMS logic to validate formatting and data accuracy. Universe Scrubber Capable of validating and cleaning massive datasets (100,000+ records per minute) to identify and correct issues before submission. Universe Generator & Aggregator Generator consolidates raw, unstructured data into compliant universe files. Aggregator merges data from systems, departments, and delegates into a single submission-ready file, paired with compliance insights. Part C & D Reporting Tools Tailored for Medicare Advantage & Part D, these modules automate file generation and scrubbing for CMS-specific reporting requirements. Self-Service Configuration Compliance teams can customize templates, workflows, and validation rules without heavy IT input.

Delegation/Vendor Oversight Management

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A comprehensive, AI-powered, cloud-native suite designed to help health plans—such as Medicare, Medicaid, and commercial payers—streamline and secure their oversight of delegated entities. Key Highlights: Modular, Unified Platform: Whether you’re just starting out or scaling up, you can adopt the specific modules you need—Delegate Determination, Repository, Audit & Corrective Action (CAP), Reporting & Monitoring—on a single, integrated platform. Enterprise-Wide Visibility & Automation: Replace fragmented spreadsheets and siloed systems with unified dashboards, automated data ingestion, real-time alerts, and streamlined workflows. CMS and NCQA-Ready Compliance: Built with regulatory requirements in mind, the suite includes CMS-aligned audit templates, universe scrubbing tools, corrective action tracking, and embedded compliance logic to maintain audit readiness. Improved Efficiency & Reduced Risk: Track KPIs, manage audits, delegate portals, appeals/grievances, member interactions, and perform data scrubbing—all with configurable thresholds and AI-powered insights—to lower audit lag, reduce compliance penalties, and optimize operations. Enhanced Accountability & Team Collaboration: The system supports role-based access, task assignments, audit trails, and a central repository—making oversight more transparent, collaborative, and defensible.