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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
  • Welcome to a New Era of Healthcare Compliance

    Usher, the generative AI Compliance Assistant

    Designed to seamlessly integrate with an industry-leading Healthcare Compliance Operating Platform, Usher can transform and accelerate the productivity of business users within the healthcare industry.

    Powered by a state-of-the-art Large Language Model (LLM) Deep Learning engine, Usher offers an unparalleled regulatory and policy compliance experience.

    To date, healthcare organizations have been able to achieve:

    Get Your AI Compliance Assistant

      Usher Features

      Usher is designed to help business users manage the complicated and constantly shifting healthcare regulatory environment by effectively summarizing  data on healthcare compliance, rules and standards. But that’s not all. Usher can be trained to learn your healthcare organization’s Policies & Procedures (P&P) content, which greatly enhances regulatory and P&P compliance.

      The goal is to help people see data in new ways, discover insights, unlock endless possibilities, starting with the ability to:

      1. Analyze Regulations and Policies

      Usher takes the hassle out of deciphering complex regulations and policies. Leveraging advanced machine learning algorithms, it meticulously analyzes the vast array of regulatory and policy documents to extract the most relevant information. Whether it’s industry-specific guidelines, government regulations, compliance frameworks, or operational policies and procedures, Usher delivers accurate and up-to-date insights to ensure your organization remains fully compliant.

      2. Respond Comprehensively

      Say goodbye to lengthy and time-consuming manual research. Usher provides comprehensive responses to your compliance queries in a fraction of the time. By understanding the nuances of your questions, it delivers precise and relevant answers, eliminating the need for extensive manual investigation. From clarifying specific compliance requirements to addressing complex regulatory scenarios to analyzing your policy and procedure content, Usher has you covered.

      3. Access Latest Updates

      Effortlessly access the information you need, right when you need it. Usher seamlessly integrates with your organization’s source data, ensuring that the insights and recommendations provided are based on the most accurate and up-to-date information available. By tapping into your existing data repositories, Usher streamlines the compliance process, saving you valuable time and effort.

      Usher Benefits


      With Usher, regulatory and policy compliance becomes easier than ever. Empower your business users with a revolutionary tool that simplifies complex regulations, responds comprehensively to your policy queries and seamlessly integrates with your source data. Embrace the future of compliance and unlock unprecedented levels of productivity, such as:

      1. Enhanced Regulatory and P&P Compliance

      By leveraging Usher, healthcare organizations can ensure a higher level of regulatory and P&P compliance. Its ability to analyze regulations, and be trained on your policies and procedures — coupled with its comprehensive responses — ensures that healthcare organizations stay up to date with the latest compliance requirements. This reduces the risk of non-compliance and potential penalties, safeguarding the organization’s reputation and improving overall member experience.

      2. Increased Productivity

      Since Usher integrates with Inovaare’s industry-leading Compliance Operating Platform, it streamlines and accelerates the compliance process. With automated analysis and comprehensive responses, healthcare organizations can save significant time and resources that would otherwise be spent on manual research. This empowers business users to focus on more strategic initiatives, boosting productivity.

      3. Accurate and Reliable Insights

      The advanced generative AI engine that powers Usher ensures delivery of accurate and reliable insights. By analyzing vast amounts of regulatory and P&P information, Usher provides precise and up-to-date information, reducing the risk of misinterpretation or outdated guidance. This accuracy in compliance knowledge enables organizations to make informed decisions, minimizing compliance-related risks.

      4. Seamless Integration with Source Data

      The integration of Usher with source data ensures that healthcare organizations gain access to the most relevant and current information. By tapping into existing data repositories within Inovaare’s Compliance Operating Platform, Usher delivers insights based on accurate and real-time data. This integration eliminates the need for manual data gathering and reconciliation, enabling faster decision making and reducing the likelihood of errors.

      5. Cost Savings

      By automating manual research processes and providing comprehensive responses, Usher helps healthcare organizations reduce operational costs. The time and resources saved can be allocated to other critical areas, improving overall cost efficiency. Additionally, Usher’s ability to identify compliance gaps or areas of improvement can help prevent costly compliance violations and potential legal consequences.

      6. Improved Collaboration and Communication

      Usher acts as a central knowledge hub, accessible to all of your business users. Its comprehensive responses and deep understanding of regulatory requirements facilitate effective collaboration and communication within the organization. This promotes a culture of compliance, ensuring that all stakeholders are aligned and equipped with the necessary information to meet regulatory obligations.

      Usher Privacy and Security


      Inovaare places the utmost importance on the privacy and security of your sensitive information. And, since Usher integrates with an industry-leading Compliance Operating Platform with HITRUST CSF® Certification, you can rest assured regarding Inovaare’s commitment to managing risk, improving our security posture and meeting compliance requirements. This prestigious certification validates our dedication to safeguarding your data and places us among an elite group of organizations worldwide.

      Inovaare’s Commitment to Your Privacy and Security includes:

      1. Comprehensive Data Protection

      Inovaare implements industry-leading security controls to protect your personal and sensitive information from unauthorized access, use or disclosure. These measures include encryption, access controls, network security, and regular monitoring to identify and address potential vulnerabilities.

      2. Compliance with Regulatory Standards

      The HITRUST CSF Certification demonstrates Inovaare’s compliance with key regulations and industry standards. Inovaare prioritizes adherence to data protection laws, such as the General Data Protection Regulation (GDPR) and the Health Insurance Portability and Accountability Act (HIPAA), ensuring that your data is handled in accordance with applicable requirements.

      3. Ongoing Risk Management

      Inovaare employs a robust risk management framework to identify, assess and mitigate potential security risks. Regular risk assessments, vulnerability scanning, and penetration testing are conducted to proactively address any vulnerabilities and ensure that your data remains secure.

      4. Employee Training and Awareness

      Inovaare understands that maintaining a strong security posture requires the involvement of every member within the organization. As such, Inovaare provides regular training and awareness programs for its employees to ensure they understand their roles and responsibilities in protecting your privacy and maintaining the highest standards of security.

      5. Transparent Privacy Practices

      Inovaare is committed to transparency regarding its privacy practices. Inovaare’s Privacy Policy outlines the types of information it collects, how it’s used, and with whom it may shared. Inovaare believes in empowering you to make informed decisions about your data and providing you with the necessary tools to manage your privacy preferences.

      The Future of Usher

      Inovaare will be incorporating Usher into its Risk Management, Compliance, Appeals & Grievances solutions to revolutionize your journey towards continuous regulatory compliance and improved member experience. By leveraging Usher’s comprehensive responses, and seamless integration with source data, your organization will experience streamlined processes, improved accuracy, enhanced risk management, increased productivity, and real-time monitoring and reporting.