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AI-powered Health Plan Solutions for Medicare, Medicaid plans AI-powered Health Plan Solutions for Medicare, Medicaid plans

AI-Powered Healthcare Payer Solutions

Empowering Health Plans with Powerful Operation and Compliance Solutions

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AI-Powered Operation and Compliance Solutions for Healthcare Payers

  • Appeals & Grievances

    Appeals and grievances system with built-in compliance, workforce management and one-click universes

  • Audit Readiness

    CMS universe management system for one-click universe generation and on-demand scrubbing of all universe tables for issue identification within minutes

  • Risk & Compliance

    The CMS compliance module aligns with the latest CMS updates (i.e., HPMS) and helps plans create accurate risk assessments, manage corrective action plans (CAPs) and assign delegated tasks.

  • Data Warehouse

    Centralized data repository for on-demand analytics and reporting through user-friendly, scalable interfaces that require minimal administration.

  • Reporting & Analytics

    Business intelligence system with advanced reporting and analytics as well as ad hoc report and dashboard generation

  • CRM Member/ Provider
  • Appeals & Grievances
  • Audit Readiness
  • Risk & Compliance
  • Data Warehouse
  • Reporting & Analytics

  • CRM Member/Provider

    Customer Relationship Management system exclusively focused on the operational and regulatory needs of health plan

  • Appeals & Grievances

    Appeals and grievances system with built-in compliance, workforce management and one-click universes

  • Audit Readiness

    CMS universe management system for one-click universe generation and on-demand scrubbing of all universe tables for issue identification within minutes

  • Risk & Compliance

    The CMS compliance module aligns with the latest CMS updates (i.e., HPMS) and helps plans create accurate risk assessments, manage corrective action plans (CAPs) and assign delegated tasks.

  • Data Warehouse

    Centralized data repository for on-demand analytics and reporting through user-friendly, scalable interfaces that require minimal administration.

  • Reporting & Analytics

    Business intelligence system with advanced reporting and analytics as well as ad hoc report and dashboard generation

Improve Member Experiences

Ensure Faster Issue Resolution

Achieve Continuous Audit Readiness

Mitigate Risk for Better Operational Health

Make Better Decisions with Real-time Reports

Appeals and Grievances

Resolve the disconnect between multiple legacy systems to effectively engage members at every touchpoint in real time.

  • Adhere to appeals and grievances compliance deadlines and requirements
  • Monitor changes at each state of the complaint process
  • Track and trend sales allegations outcomes
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Audit & Monitoring

Efficiently audit and monitor compliance readiness by centralizing and automating critical processes.

  • View audits and monitor process data in real time
  • Track findings, recommendations and action plans
  • Generate on-demand reports and analytics
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Risk Management

Risk Management

Confidently guide health plans to manage risks relevant to their businesses with real-time data.

  • Manage contract life cycles
  • Implement contract analytics
  • Track all contract parameters
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Automate Health Plan Operations and Compliance Management life cycle

Inovaare partners with health plans to deliver AI-driven automation solutions that populate compliance, operations and analytics tools with real-time data to guide oversight and generate compliant regulatory reports at the touch of a button.

  • Drive compliance with the latest regulatory protocols embedded
  • Conduct regular mock audits and monitor process data in real time
  • Improve A&G turnaround times for better member experiences
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Client Testimonials

"We appreciate Inovaare team for working with us and helping to identify ways to improve our process in the Inovaare platform. We will continue to work with the team on other opportunities."
Kristi Cooper RN, BSN
Managing Director, Clinical Operations‐Medicare Plans
Advantasure
"I feel we made the right choice with Inovaare as they have been an incredible partner. The scrubbers and platform were tested during CMS TMP reviews and our CMS Comprehensive Program Audit last year. Our CPE audit results were excellent, and we had no findings. Authentic team and platform that works!"
Mayra R. Campuzano, CHC
Vice President, Compliance Officer
Doctors Healthcare Plans Inc
"Thank you to all involved. It's a great first step in improving our efficiencies. This is a partnership, and we appreciate the support."
Connie Minerich
Senior Vice President, Operations
Advantasure
"I just want to take a minute more of your time to let you know how grateful I am for your partnership and support. I recognize how much effort you put into responding promptly (even when it is isn’t necessary!), making sure I am informed of changes, walking me through how to do things when needed, etc. You are very knowledgeable and always willing to help, which I very much appreciate. You are also kind, patient, and friendly, so a pleasure to work with. Simply stated, thank you! Thank you for everything you do."
A Senior Compliance Professional from a Leading U.S. Health Plan
"Thank you for all your hard work, dedication, and selflessness that you give to our CHG Team. Your commitment to helping our team never seizes to amaze me. You are always working above and beyond normal expectations to support and improve our services. The enthusiasm you bring to the table brings a smile to face and it is such a joy to work with you. With your help we have been able to develop and implement ideas that will enhance and improve our processes and productivity."
Daphne Cheney, Corporate Quality Project Coordinator, Community Health Group (CHG)
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Markets Served

Empowering health plans to sustain federal, state and commercial compliance.

Medicare

Centralize MA/MAPD program requirements, automate CMS compliance processes and monitor compliance initiatives in real time.

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Medicaid

Establish and operate effective compliance programs to determine if your departments and providers meet regulatory requirements.

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Commercial

Provide better member service for improved member experience, enhance provider engagement, and maintain contracted service levels.

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PBM

Improve compliance and quality management requirement oversight of pharmacy benefit managers and operations.

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Obtain a quick understanding of how Inovaare drives digital transformation within the healthcare industry through our growing video library. While some of our videos are dramatic and others are entertaining, they’re always informative.

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Blogs

A perspective on recent industry shifts influencing ACA plan operations in states, which are yet to adopt ACA Medicaid expansion

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Webinars

Experience why Inovaare remains a trusted authority within the healthcare industry. All presenters are industry thought leaders who make your interests a priority.

Case Studies

Don’t just take our word for it. Learn how existing Inovaare clients benefit from Inovaare’s digital transformation, backed up by real-world results.

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Collateral

If you need automated A&G, Regulatory Compliance or CMS Program Audit solutions, you can find your answers here.

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Visit our eBook library and experience why Inovaare is a trusted industry thought leader. Check back regularly as we will continue to provide unparalleled insight into Appeals & Grievances and Risk & Compliance best practices.

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