What we do Client outcomes
Identify and implement:

  • Standardized processes and tools to support/create:
    • Ongoing Quality Assurance Program
    • IV&V Program
    • Regulatory Reporting
  • Perform Mock Audits:
    • Determine Compliance Risks to prevent future Regulatory Corrective Action Plans (CAPs)
    • Identify Cross Functional Process Improvements
  • Audit Support:
    • Review/Develop Audit Universes
    • Prepare Responses to Audits and the documentation requested
    • Develop, Execute and Oversight of Corrective Action Plans (CAPs)
  • Negotiate settlements as necessary
Proven results:

  • Reduced Audit findings and Compliance costs
  • Improved Process Controls affording smoother Regulatory Audits
  • Alignment with CMS and State Regulations.
  • Increased CMS STAR Ratings
  • Established effective and repeatable oversight and quality control tools
  • Regulatory reporting readiness
  • Reduced Member and Provider Complaints
  • Decreased Appeals and Grievances
  • Identification of operational gaps
  • Opportunities for resource training