Improve member experience with real-time data
Medicare Advantage and Medicare Advantage Prescription Drug (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 and process claims with greater speed and accuracy. Inovaare’s integrated platform empowers Medicare payers to: centralize MA/MAPD program requirements, automate CMS compliance processes and monitor compliance initiatives in real time.
Increase administrative and operational efficiency
To be at the top of the Medicaid segment, payer plans must reduce operational inefficiencies, especially since Medicaid program administration is plagued by rampant insurance fraud and abuse. Detecting and deterring these criminal elements form the core of quality compliance audit tools. Inovaare’s suite of comprehensive solutions for Medicaid providers addresses: claims processing, medical management, administrative activities and network management. Inovaare supports Medicaid providers, including hospitals, to navigate the complex maze of Medicaid audit processes. Inovaare’s audit solution for Medicaid compliance helps payer plans to investigate suspicious provider activity, allowing them to quickly recover illegitimate claims, if processed, and track provider compliance with Medicaid program statutes.
Automate WITH COMPLIANCE DESIGNED INTO THE CORE
To successfully move the needle in member experience, commercial health plans must improve member care and promote their unique selling proposition. This will empower them to compete in a cluttered marketplace. Backed by over 125 years of leadership experience within the commercial health plan industry, Inovaare possesses unparalleled understanding of the challenges within the environment. Some of the largest commercial health plans in the United States trust Inovaare to guide them regarding unique state and contracting rules to help them provide better member service, improve provider engagement, increase star ratings and ensure they maintain enterprise-wide compliance.
Establish Compliance Oversight
Pharmacy Benefit Management
Based on recent finding from audits, the CMS increased oversight on pharmacy benefit management (PBM) operation. PBMs process a large volume of transactions and are responsible for complying with CMS and state regulations, as well as service-level agreement requirements of their clients. Inovaare’s next-generation cloud platform provides multiple solutions to address compliance and quality management requirements of PBMs and pharmacy operations.