Reduce manual oversight tasks by 60% - while gaining full visibility into every delegate.

Inovaare Delegation Oversight is designed for health plans operating Medicare Advantage, Medicaid, and Commercial lines of business. It is used by Chief Compliance Officers (CCOs), VP/Directors of Delegation Oversight, Audit & Risk Management teams, Vendor Management & Quality teams, and Operations leadership who need to manage the full delegation lifecycle — from pre-delegation assessment through ongoing monitoring, audit, and corrective action. The platform is purpose-built for organizations managing multiple delegated entities across multiple functions and lines of business, who need centralized visibility, automated workflows, and CMS-ready audit trails — not spreadsheets and email-based tracking.

Under CMS regulations, health plans may delegate functions such as claims processing, appeals and grievances, utilization management, credentialing, and quality improvement, among others. The specific functions that can be delegated depend on plan type and applicable CMS guidelines. However, the health plan retains ultimate accountability for all delegated functions. Inovaare tracks each delegated function by entity, contract, and line of business — with performance KPIs, audit schedules, and compliance requirements specific to each function type.

Inovaare tracks delegate performance through configurable KPI scorecards with tolerance thresholds for each delegated function. The system monitors metrics like timeliness, accuracy, member notification compliance, and other CMS-required performance indicators. When a delegate falls below defined thresholds, the system automatically flags the deficiency, triggers alerts to oversight teams, and can initiate corrective action workflows. Real-time dashboards provide visibility into performance trends across the entire delegate population.

When a deficiency is identified through monitoring or audit, the system initiates a Corrective Action Plan (CAP) linked to the specific delegate, function, and finding. CAP owners are auto-assigned with deadlines based on severity. The platform tracks CAP status, sends automated reminders, and triggers escalation workflows for overdue items. Delegates respond and submit evidence through their dedicated secure portal. The oversight team reviews, validates, and closes CAPs with full traceability — documented for CMS/OIG review.

Yes. Inovaare includes a pre-delegation determination module where you can create vendor profiles, conduct assessments, and evaluate potential delegates against your criteria before delegating any function. The assessment covers operational capabilities and compliance infrastructure. Entities that pass move into the delegation repository with all assessment documentation preserved for audit trail purposes.

Every delegated entity gets a dedicated secure portal where they can view assigned tasks, upload required documents, respond to audit requests, submit universe data through the integrated scrubber, and track their performance against contractual KPIs. The portal eliminates email-based back-and-forth and ensures all delegate interactions are logged with timestamps. Tasks are auto-assigned based on audit and monitoring schedules.

Yes. Inovaare’s modular architecture lets you deploy Delegation Oversight as a standalone module and add connected modules as your program evolves. Many health plans start with delegation oversight and expand to the Regulatory Library, Policies & Procedures, and KPI Monitoring over time. Each module integrates natively — compliance requirements link to the Regulatory Library, delegation policies are version-controlled in P&P, and performance data feeds KPI dashboards. Modular licensing means you pay only for what you deploy.

Inovaare uses enterprise licensing with modular pricing — you pay only for the modules you deploy. Delegation Oversight can be purchased standalone or bundled with complementary modules such as Regulatory Library, Policies & Procedures, or KPI Monitoring. Pricing is based on organization size, number of delegated entities, and module selection. Contact our team for a custom quote tailored to your health plan’s delegation program scope.