What we do Client outcomes
Develop and implement:

  • Regulatory Matrix to establish operational and system requirements in accordance with CMS/State regulations
  • Functional area workflows
  • Business and system requirements
  • Functional area test case scenarios
  • CMS/State/Vendor data file exchanges
  • Policy and Procedures
  • Desktop Level Procedures (DLPs)
  • Training Materials for functional areas
  • Regulatory and Internal Operational Reporting
  • Executive Dashboards
  • Audit Universe Development and Testing
  • Post Go-Live support
Proven results:

  • Compliant Operations aligned with CMS and State Regulations
  • Effective Operational Processes and Controls
  • Successful Regulatory Audits
  • Reduced Risk of Non-Compliance findings
  • Regulatory Reporting Readiness
  • Program insight at Executive and Operational levels
  • Resources that are prepared, confident and knowledgeable for Go-Live support
  • Reduced Risk of Member and Provider Complaints, Appeals and Grievances