Compliance maintenance and oversight for health plans can be a resource and time-consuming restraint. Challenges with manual processes, inefficient workflows and frequent compliance audits prove to be disruptive and expensive. Regulatory demands for health plans can result in higher costs, increased resources, and unplanned expenses.

Common compliance concerns include:

  1. Conflicting directives for health plans with multiple regulators
  2. Un-finalized regulations causing uncertainty on ongoing lawsuits
  3. Regulatory timeframes shortening the window of time for review of compliance processes and protocols
  4. Significant changes and implementation needs to comply with healthcare reform, or the routine changes
  5. Frequent regulatory revisions and sub laws making it difficult to maintain compliance

Health plans are increasingly seeking solutions to streamline their compliance and quality processes and deliver better patient care. Software automation has gained a lot of attention and increased adoption to facilitate compliance. Proactive and technically-advanced health plans have automated their core business and operational processes. This has included handling sensitive patient information, validation of insurance coverage, appointment management, medical billing and records management.

Compliance automation not only reduces errors but also ensures protection of critical patient data which allows for better care management. Automation software allows the user to generate powerful and insightful reports that aid in decision making, business planning and overall compliance adherence.

Inovaare’s Healthcare Cloud Platform provides a unique and comprehensive, yet simple framework. This platform allows health plans to transform their complex business processes and disparate data sources into a centralized and streamlined information management system.

Inovaare’s solutions allow health plans to determine whether they adhere to the rules and procedures necessary to ensure operational or regulatory compliance  across all their functions.

Through our CQMS TracX health plans can centralize, streamline and automate process management. Complex and cross-functional process become easier to manage. This can include customer issue management such as appeals, grievances and complaints, Regulatory and compliance events and reporting, incident investigations, correspondence and other activities.

With the CQMS Audit module, health plans can easily perform audits and assessments efficiently and timely without disrupting the day to day operations. These may also include on-going monitoring and oversight of their business associates and delegated entities. This easy-to-use system helps schedule assessments, track progress, and manage corrective action plans in a centralized platform.

Health plans will continuously be in need of adjusting to ongoing regulation changes and requirements. Understanding the new and changing laws can prove to be cumbersome and may require additional compliance oversight. In order to be at the forefront of competition, health plans must adopt technology solutions to automate their core processes to help shift resources and focus on the more demanding and productive areas. Compliance and quality automation software is the solution to achieve balance between the compliance and quality needs.