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How Health Plans Can Overcome the Single Biggest IT Challenge: Having A Single Source of Truth - Inovaare How Health Plans Can Overcome the Single Biggest IT Challenge: Having A Single Source of Truth - Inovaare

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    Reporting

    • 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

    Monitoring

    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
  • Free eBook: How Health Plans Can Overcome the Single Biggest IT Challenge: Having A Single Source of Truth

    Unlock the Power of
    Unified Data Management

    In the digital age, health plans face a critical challenge: consolidating data from disparate sources to create a single source of truth. Our eBook, “How Health Plans Can Overcome the Single Biggest IT Challenge: Having A Single Source of Truth,” provides a comprehensive guide to understanding and implementing effective data integration strategies.

    Who is this eBook for?

    This guide is essential for IT professionals, data managers, and decision-makers in the healthcare sector, particularly those involved with Medicare, Medicaid, and Commercial health plans. If you are striving to reduce data discrepancies and foster a reliable data ecosystem, this eBook is tailored for you.

    What’s Inside?

    Why Download?

    Don’t let data disarray hold you back. Fill out the form now to download your free copy of the eBook “How Health Plans Can Overcome the Single Biggest IT Challenge: Having A Single Source of Truth,” and start transforming your data management approach today.

    For more information, contact us at 1.408.850.2235.

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