Medicare Advantage

Centralize, Streamline and Automate Compliance Processes in Real Time

A powerful payer platform Medicare Advantage and Part D (MA/MAPD) plans face very specific set of challenges to optimize administrative processes and in meeting CMS compliance requirements. Payer organizations are beginning to realize that implementing automation software for claims adjudication could go a long way in eliminating duplication and errors resulting in processing claims with speed and accuracy. The unified platform allows payers to meet changing regulatory mandates.

Inovaare’s suite of compliance solutions for Medicare payers allows MA/MAPD plans to centralize, streamline and automate compliance processes in order to meet CMS requirements and monitor compliance initiatives in real time.

Appeals & Grievances

Medicare Advantage plans must adhere to rigorous standards for handling grievances and appeals from both members and providers. Inovaare’s A&G solution is a highly configurable tool for managing multiple workflows, documentation, and resolutions for these complex processes that span multiple departments and external entities.

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Compliance Management

The regulatory and compliance department needs to track various events and manage corrective action plan effectively while enforcing the policy to the various business department. Inovaare’s compliance solution includes compliance work plan management, event tracking, Issue and CAP management.

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Broker Oversight Management

Inovaare broker management solution helps health plans and broker organizations to effectively manage broker lifecycle activities, including broker registration, training, certification and internal broker compliance program.

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 must have a third party auditor to validate the reports prior to submission to CMS. Inovaare has worked closely with MA/MAPD plans to develop a software solution for managing this process more effectively across multiple organizations, including delegated entities.

Delegation Oversight

Inovaare’s Delegation Oversight solution assist Medicare Advantages health plan to manage and track the various audits and file reviews it performs for the delegated entities in the areas of Credentialing, Utilization Management, Quality Improvement and other delegated functions.


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