Audit management solution for health plans
Save up to $500k annually on audit operational cost.
A governed audit management system that delivers traceable evidence collection, defensible sampling, and CMS-aligned reporting across internal and external audits. Built for Medicare Advantage, Medicaid, and ACA health plans.
Why This Matters
Your audit operations are costing more than they should.
chasing evidence
Manual evidence gathering burns FTE hours
Audit evidence is scattered across teams, email inboxes, shared drives, and legacy systems. Staff spend weeks chasing documents that should be automated.
weeks per cycle
Audit prep consumes entire teams
Manual coordination of universes, evidence collection, sampling and corrective actions drains resources for weeks every audit cycle.
audit systems
Fragmented tools multiply rework
Siloed audit systems. Audit findings, evidence, and CAPs live across disconnected tools with limited cross-view. Teams duplicate collection effort and corrective actions disconnect from the findings that triggered them.
real-time view
Leadership lacks audit visibility
No consolidated view of audit status, evidence readiness, or risk exposure. Decisions rely on stale snapshots and manual status reports.
What Leaders Say
Trusted by compliance and audit leaders at health plans.
Built for Your Role
Audit outcomes tailored to what matters most to you.
Whether you own the compliance posture, the audit function, or the budget, Inovaare delivers the outcomes your role demands.
Continuous Audit
Defensibility
Replace reactive audit season with year-round readiness. Every action logged, every finding linked to CAPs, every report CMS-ready so you can demonstrate governance before regulators ask.
- Up to 90% fewer repeat findings
- Centralized evidence ensures regulator readiness
- Full audit trail on every action
Structured Workflows, Not Spreadsheet Chaos
Replace ad hoc coordination with governed audit workflows. Evidence collection, sampling, and report drafting follow standardized steps so your team spends time on findings review, not process management.
- 5–7 FTEs freed annually
- AI-generated audit reports in minutes
- Risk-weighted sampling with zero manual selection
Defensible Audit Posture with Lower Operational Drag
Reduce consultant dependency and shift compliance investment from manual coordination to risk reduction. Build the structured evidence and traceability regulators expect to see.
- Up to $500K annual savings
- Reduced consultant dependency ($150–$200/hr saved)
- Higher pass rates, stronger star ratings
The Transformation
What audit management looks like with Inovaare.
| Area | Before Inovaare | After Inovaare |
|---|---|---|
| Audit Planning | Manual scheduling, spreadsheet tracking | Configurable templates, automated scheduling |
| Evidence Collection | Email requests, shared drives, manual tracking | Auto-ingest from integrated systems, centralized repository |
| Sampling | Manual selection, potential bias | AI-driven, risk-weighted, bias-free sampling |
| Findings Management | Disconnected from corrective actions | Automated CAP creation linked to findings |
| Report Generation | Days of manual compilation | AI-generated reports in minutes |
| Audit Trail | Incomplete, manual notes | Every action timestamped automatically |
| CMS/OIG Compliance | Reactive, audit-season only | Continuous readiness, year-round |
| Collaboration | Email chains, SFTP confusion | Secure collaboration with complete audit logs |
Return on Investment
Measurable ROI across four dimensions.
Inovaare Audit Management delivers measurable return across time savings, cost efficiency, risk reduction, and compliance ratings.
Annual savings from 5–7 FTEs freed
Evidence gathering, sampling & reporting automated
Faster audit prep cycle
From 6–8 weeks down to ~1 week, with full evidence traceability and version-controlled sampling logs.
Average CMS penalties avoided per cycle
Continuous readiness prevents audit failures
Audit report drafting time
AI drafts structured reports from findings data, with human-in-the-loop validation and full audit trail.
Disclaimer: Based on observed outcomes across health plan implementations. Reported ranges; actual results vary by case mix, data volume, and current process maturity.
How It Works
From planning to closure, every step is governed and traceable.
Launch & Plan
Set up a new audit with scope, owners, deadlines, and CMS-program templates pre-configured. Prior cycles link in automatically, giving you version-controlled institutional memory from day one.
Document Collection
Evidence requests route to functional owners with deadlines, role-based access, and escalation paths built in. Every request and response logs to the audit, removing the back-and-forth that consumes weeks of each cycle.
Submission & Validation
Every submission is validated against documented standards before acceptance, and rejected items return with traceable comments. The outcome is a defensible evidence chain that meets CMS and OIG documentation expectations.
Insights & Sampling
Risk-weighted sampling runs against configurable criteria, with methodology logged for regulatory review. Auditors retain oversight to add or refine samples, keeping the selection defensible to CMS without the manual selection burden.
Findings & Reports
Preliminary findings are drafted with citations to the underlying evidence, ready for auditor review before issue. Each accepted finding spawns a linked Corrective Action Plan automatically, closing the loop between identification and remediation.
Closure & Communication
Audit closes with a complete chain of custody. Every action timestamps against its originating finding, and cross-cycle dashboards surface where governance is strengthening or where repeat-finding patterns warrant attention.
Why Inovaare
Your audit system should know what CMS expects.
Many plans are re-evaluating how audit workflows are tooled. Evidence often lives across spreadsheets, shared drives, and email; sampling is largely manual; and corrective actions sit outside the audit findings that prompted them. Each cycle restarts from scratch because nothing is linked.
Generic Audit & GRC Vendors
- Generic audit tools not built for healthcare payer workflows
- No CMS-specific templates, sampling rules, or compliance logic
- Siloed from CAP, evidence, and compliance modules
- Evidence gathering remains manual: email requests and shared drives
- Generic GRC platforms typically include AI features as add-ons rather than as a purpose-built layer for audit workflows.
Inovaare Audit Management
- Purpose-built for CMS, OIG and state audits at U.S. health plans
- Pre-built templates aligned to CMS audit requirements and programs
- Closed-loop integration with CAP, Incident Management, and Delegation Oversight
- Auto-ingest evidence from claims, appeals, grievances, and provider systems
- Usher AI powers sampling, evidence tagging, summarization and report drafting
Getting Started
Ready to scope your audit management program?
Connected Platform
Modules that extend audit management across your enterprise.
Each module is optional and priced separately. Layer them onto core Audit Management as your program grows.
CAP Management
Central hub for corrective actions from audits, incidents, KPIs, delegation reviews, and compliance gaps. AI summarizes CAPs, recommends closure steps, and flags recurring patterns. Reduces CAP closure from 90+ days to ~30 days, saving 2–3 FTEs (~$200K–$300K annually) with 80–90% fewer repeat deficiencies.
Incident Management
Centralized intake with AI auto-classification across compliance, operations, IT, vendor, and member categories. Configurable workflows by incident type, automated triage, SLA monitoring, and incidents feed directly into audit findings. Reduces manual compliance hours by 40–60%.
Universe Management
Auto-generates CMS-ready universes (ODAG, CDAG, SNP-MOC, FDR) from live operational data. Applies CMS layout, logic, and validation rules, flags defects with correction guidance, and exports submission-ready files. Reduces universe prep from weeks to hours.
Resources
Evaluate on your timeline.
Self-Serve
Readiness Assessment
Evaluate your readiness across critical
audit areas.
Start Assessment
On-Demand
Recorded Product Walkthrough
Watch an overview of the platform at your own pace, then share it with your evaluation team.
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Self-Score
Compliance Variability Exposure
Evaluate your plan’s compliance posture based on the five Pillars of Compliance Stability
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Frequently Asked Questions
Common questions about
Inovaare Audit Management.
Inovaare Audit Management supports both internal and external audits across all lines of business. This includes Medicare Advantage audits – CMS program audits (ODAG, CDAG), OIG audits, state Medicaid audits, mock audits, internal compliance reviews, and delegation oversight audits. Each audit type follows configurable workflows with templates, evidence requirements, and compliance rules specific to the audit program and regulatory body.
The system eliminates manual audit preparation through four key automations: configurable templates standardize planning so teams start from structured frameworks rather than blank spreadsheets; automated evidence collection pulls documents directly from integrated claims, appeals, and provider systems; AI-driven sampling selects risk-weighted samples without manual selection or bias; and automated report generation drafts findings reports in minutes rather than days. Together, these automations compress the 6–8 week prep cycle into approximately one week.
The Sampling Agent uses risk-weighted algorithms to automatically select audit samples based on configurable risk criteria, case attributes, and historical patterns. The selection is bias-free and defensible for regulatory review. Auditors retain full control — they can review, adjust, or manually add samples. The system integrates with the Universe Scrubber to ensure sampling accuracy before submission. This replaces manual sample selection which is time-consuming and prone to selection bias.
When an auditor identifies a finding, the system automatically creates a Corrective Action Plan (CAP) in the integrated CAP module. Each CAP is linked to the originating audit finding with full traceability — including audit ID, finding category, severity, and remediation timeline. CAP owners are auto-assigned, deadlines set based on severity, and escalation workflows trigger automatically for overdue items. This closed-loop integration ensures no finding falls through the cracks.
Yes. Inovaare’s modular architecture lets you deploy internal audit capabilities first and add external audit, CAP management, delegation oversight, or other modules as your program grows. Many health plans start with core audit management and expand to connected modules over time. Modular licensing means you pay only for what you use.
Most health plans are live within 8–12 weeks depending on the number of audit programs, integrations, and workflow configurations. The platform is low-code/no-code, so compliance and audit teams can configure templates, workflows, and reporting without IT dependency. Inovaare provides implementation support including audit workflow configuration, system integrations, data migration, and user training.
Yes. The audit management system connects to standard health plan data sources including claims systems, appeals platforms, grievance tracking, provider files, and delegation management systems via APIs. Evidence is auto-ingested from these integrated systems, eliminating manual document gathering. The platform also integrates natively with Inovaare’s CAP, Incident Management, Delegation Oversight, and Regulatory Library modules.
Inovaare uses enterprise licensing with modular pricing — you pay only for the modules you deploy. Audit Management can be purchased standalone or bundled with connected modules like CAP Management, Incident Management, or Delegation Oversight. Pricing is based on organization size and module selection. There are no per-user seat fees for standard audit workflows. Contact our team for a custom quote tailored to your health plan’s audit program scope.
See end-to-end audit management in 30 minutes.
Walk through how Inovaare governs audit planning, evidence collection, sampling, and CAP closure across CMS, OIG, and state audits, with your workflow.
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