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HICE

Streamlining Universe submissions for a Fortune 500 Health Insurer 

Fortune_500_Health_Insurance

Highlights

Quantifiable Results

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reduction in time spent on data scrubbing
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reduction in audit review time
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reduction in the cost of audit follow-ups
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reduction in time spent aggregating universe data
“Inovaare's UMS solution significantly cut down the error count and drastically improved our ability to submit CMS-compliant universes more quickly. We now view it as an essential tool for the entire organization.”

The Customer

The client is a Fortune 500 American health insurance provider dedicated to delivering quality healthcare solutions. With thousands of employees, the health plan serves millions of members across the U.S., offering a wide range of health insurance products and services. It is committed to enhancing health outcomes through innovative solutions and exceptional customer service.

Challenges

Before implementing Inovaare’s Universe Management System (UMS), the health insurance provider faced several issues with their audit and compliance processes:

“Our compliance team members frequently complained about spending too much time auditing, reviewing and creating CMS-compliant universes. It was extremely challenging to consistently review each universe to validate fields are populated correctly.”

Goals

The health insurance provider decided to adopt Inovaare’s Universe Management System (UMS) to enhance their audit and compliance processes. Their specific goals included:

Solution

After evaluating several technology solutions, the health insurance provider selected Inovaare’s Universe Management System (UMS) due to its robust automation capabilities, built-in compliance rules, and comprehensive data management features. The key aspects of the solution deployment include:
“Inovaare’s UMS enabled our organization to create a risk-based audit plan with a well-defined objective and scope, in tandem with quality, compliance and universe management processes.”

Benefits

The implementation of Inovaare’s Universe Management System (UMS) has provided the health insurance provider with unprecedented levels of efficiency and accuracy in their audit processes, leading to numerous benefits:
“Inovaare shared the same sense of urgency as us to help us get through the CMS audit and that, to me, is true partnership.”

Outcomes

The implementation of Inovaare’s Universe Management System (UMS) has led to significant and measurable improvements for the health insurance provider.

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