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Automation for 2024 Program Audit Success Automation for 2024 Program Audit Success

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    • The State Regulatory Guidance (All Plan letters) responsibilities include, but are not limited to:
      1. DHCS All Plan Letter (APL) and Policy Letter (PL) Applicable Notices
      2. DHCS All Plan Letter (APL) and Policy Letter (PL) - Non-Applicable Notices
      3. Submits proof of APL and PL compliance documents to DHCS
    • The Organization Risk Assessment responsibilities include, but are not limited to:
      1. Review of new potential risks with assigned accountable business owners
      2. Provide final data set to senior executive team for implementation of agreed upon interventions
    • The Regulatory Audit Process responsibilities include, but are not limited to:
      1. Creation of audit folders
      2. Tracking of documents/universe and requests received from the auditor and distributed to the business owners
      3. Audit Readiness Questionnaires
    • The Regulatory Routine Reporting responsibilities include, but are not limited to:
      1. Maintaining calendar for all regulatory compliance
      2. Tracking timeliness of business owner’s submissions and attestation


    Continuous monitoring allows a health plan to quickly and easily keep its finger on the pulse of the delegates’ performance to identify potential risks or issues before they become major problems. This will help ensure compliance with needed regulations through the health plan’s ability to:

    • Expedite feedback processes to mitigate operational and enterprise risks
    • Utilize streamlined reporting processes to automate reviews and highlight elements that are approaching identified tolerances
    • Track findings, recommendations and corrective action plans, as well as trends over time, to quickly compare delegates and prepare for renegotiation when the time comes

    Audit and CAP

    Auditing delegated entities is essential for maintaining good governance, managing risk and ensuring compliance within an organization. Health plans can now efficiently oversee audits and perform file reviews of their delegated entities and vendors and maintain a system-wide overview of all compliance activities:

    • Deliver real-time audit results
    • Lower audit backlog, efforts and timelines
    • Help health plans with pre- and post-delegation audits of all areas of delegation
    • Create and manage Corrective Action Plans (CAP) for all audits that produce findings

    Pre-delegation audit

    The pre-delegation audit process involves a comprehensive review of the proposed delegates’ policies, procedures, and systems, as well as an assessment of their compliance with relevant technical and operational standards. The audit may also include a review of their financial stability and management structure. Our module helps guide the process through:

    • Facility Site Review audits
    • Medical Record Review audits
    • Credentialing Audits Pre- and Annual re-certification
    • Utilization Management audits including Quality Management (QM) audits
    • Special Needs Plan (SNP) audits

    Delegation repository

    Centralized database of your various delegate or vendor information, allowing health plans to easily track and manage relationships with its FDRs.

  • Demographic information
  • Contact information
  • Responsibilities or functions assigned
  • Audit activities and past performance
  • Leverage Compliance-Driven Automation for 2024 Program Audit Success

    September 13, 2023 Time: 10 a.m. to 11 a.m. (PT) | 1 p.m. to 2 p.m. (ET)

    What if you had a simple-to-use but powerful tool that could tell you all the things your compliance team is looking for and therefore CMS, prior to handing your universes over? 

    Join Brenda Wade, Chief Compliance Officer, and Gabe Viola, SVP, Operations, for our latest CMS compliance webinar, Unleashing Operational Excellence: Leverage Compliance-Driven Automation for 2024 Program Audit Success, and discover how Inovaare’s Universe Management System leverages compliance-driven automation to empower you to streamline your operational processes. 

    After attending this webinar, you’ll be amazed by how compliance-driven automation enables you to meet your Operational requirements with minimal effort. Specific takeaways will include how easy it is to: 

    • Utilize Universe Scrubber for ongoing auditing and monitoring 
    • Monitor key operational elements 
    • Achieve unparalleled FDR oversight capabilities though a real-time portal 
    • Identifying gaps in plan processes 

    Don’t miss this opportunity to engage two industry thought leaders and leverage their expertise to help you master universes. 

    If you would like to explore how our Universe Management System can fit your unique requirements, register for this webinar today! There’s never a better time than right now to be prepared. 

    Book Your Free Registration!


      Gabe Viola

      SVP Customer Relations & Implementations


      Brenda Wade

      Chief Compliance Officer