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Medicare Advantage

Centralize, Streamline and Automate Compliance Processes in Real Time

Medicare Advantage and Medicare Advantage Part D (MA/MAPD) plans face a unique set of regulatory challenges, forcing them to optimize administrative processes that comply with CMS requirements. Payer organizations are beginning to realize that implementing automation software for claims adjudication can:

  • Eliminate duplication
  • Reduce errors
  • Process claims with greater speed and accuracy

Inovaare’s integrated platform empowers Medicare payers to:

  • Centralize MA/MAPD program requirements
  • Automate CMS compliance processes
  • Monitor compliance initiatives in real time

Appeals & Grievances

MA and MAPD plans must adhere to rigorous standards for handling grievances and appeals from both members and providers. Inovaare’s Appeals & Grievances solution is a highly configurable tool that empowers Medicare payers to:

  • Manage multiple workflows
  • Centralize documentation
  • Achieve efficient A&G resolutions across multiple departments and external entities

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Compliance Management

CMS compliance teams need to track multiple events and manage corrective action plans effectively while enforcing the policy across business departments. Inovaare’s Compliance Management solution supports these processes by allowing MA and MAPD plans to:

  • Optimize compliance work plans
  • Track events in real time
  • Implement efficient Issue and CAP management plans

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Broker Oversight Management

Health plans and broker organizations face challenges to effectively manage broker lifecycle activities. Inovaare’s Broker Oversight Management solutions helps facilitate these processes by helping payer plans to:

  • Streamline broker registration
  • Implement broker training and certification programs
  • Improve internal broker oversight

Medicare Part C & D Data Validation Audits

In 2010, CMS began requiring private Medicare payers to report on a number of measures aimed at monitoring and improving quality and containing costs. Beginning in 2011, plans were required to have a third-party auditor validate the reports prior to submission to CMS. Inovaare worked closely with MA/MAPD plans to develop its Medicare Part C & D Data Validation Audits solution for managing this process more effectively across multiple organizations, including delegated entities.

Delegation Oversight

Not only do Medicare Advantage and Medicare Advantage Plan D health plans need to effectively manage their own compliance processes, CMS requires them to manage and track the various audits and file reviews it performs for their first-tier, downstream and related (FDR) delegated entities. Inovaare’s Delegation Oversight solution assists MA and MAPD plans to efficiently achieve this complicated requirement for multiple delegated functions including:

  • Credentialing
  • Utilization Management
  • Quality Improvement


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