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CMS program audit readiness playbook

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Governance, risk & compliance

GRC made simpler, smarter, and faster for payers

We empower health plans to eliminate compliance blind spots, reduce risk exposure, and stay audit-ready with a centralized, real-time GRC suite purpose-built for Medicare, Medicaid, and Commercial markets.

Governance, risk & compliance

What we solve

Why health plan GRC fails

Most health plans still manage governance, risk, and compliance through disconnected tools and manual effort. The result? Missed deadlines. Incomplete documentation. Limited oversight. And high audit risk.

No single source of truth

Policies, issues, and CAPs live across folders, emails, and teams, making version control and accountability nearly impossible.

Outdated processes

Spreadsheets and checklists can’t scale or flag risks in real time, increasing the chance of non-compliance.

Limited visibility for leadership

Risk and compliance gaps go unnoticed, causing delayed decisions, missed deadlines, and increased exposure.

No clear ownership

Scattered responsibilities with no centralized accountability lead to delays and gaps in follow-through.

How we solve

Simplify compliance. Minimize risk. Improve control.

Our GRC platform, built specifically for healthcare payers, combines intelligent workflows, automation, and real-time visibility to eliminate fragmented systems and establish consistent processes and clear ownership.

Process-first, not tool-first

We bring clarity and structure to your GRC operations with purpose-built workflows that mirror real-world needs, not just checklists.

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Automation where it matters most

From CAP follow-ups to document versioning and audit prep, we reduce manual work so your teams can focus on risk, not admin.

Connected data, smarter decisions

Policies, issues, risks, and outcomes are linked across modules—so you don’t just track activity, you learn from it.

Real-time insights

Dashboards, alerts, and task views keep leadership informed, teams accountable, and gaps visible before they become risks.

Why health plans trust Inovaare

Healthcare native. Payer trusted.

It’s not just technology. We help health plans manage risk, maintain control, and optimize operations, using a platform that’s trusted by peers.

Purpose-built for payers

Reflects real-world workflows, regulatory needs, and operational structures unique to payers.

End-to-end GRC

One connected platform to manage policies, risks, CAPs, audits, contracts, and issues—with no silos or manual handoffs.

Cross-functional impact

Compliance, finance, operations, and IT teams all benefit from unified oversight, fewer errors, and faster cycles.

Value we bring

From chasing compliance to owning it, GRC done right

Our GRC platform is more than a tool, it’s a strategic enabler. We help payers break operational and compliance silos to help drive accountability and continuous compliance.

Enterprise-wide visibility

One platform for all GRC activities, policies, risks, audits, contracts, CAPs, ensures every team operates from a single source of truth.

Faster, smarter decisions

Dashboards and reports provide leadership with the insights they need to act early, reduce risk, and stay compliant.

Lower cost of compliance

Automation, collaboration, strategic reporting, and AI agents improve operational efficiency and lower cost of compliance.

Scalability & integration

Built on a secure, API-ready architecture that connects with your existing systems and grows with your business.

Key features

Scale your GRC program with automation, insight, and control

From smarter workflows to self-service configuration, we help your GRC teams reduce risk, respond faster, and drive continuous compliance at scale.

Inovaare-One-click report generation

End-to-end audit trails

Every action, update, and decision is time-stamped and traceable, ensuring complete compliance and transparency.

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Cross-module data linking

Risks, policies, issues, and CAPs are intelligently connected for context-rich decision-making.

Centralized dashboards

KPIs, overdue tasks, and audit status updates are always visible, without needing to pull reports.

Engineered for Compliance. Designed for Efficiency.

Power your GRC operations with connected capabilities

Our GRC suite brings structure, speed, and intelligence to every part of your governance, risk, and compliance program. Whether bundled as a suite or deployed independently, our solutions deliver measurable value across the entire GRC lifecycle.

A&G management

Effortlessly manage appeals and grievances! Automate workflows, reduce manual effort, and ensure timely resolutions. Improve compliance and operational efficiency while enhancing member satisfaction with seamless, accurate, and real-time tracking of appeals and grievances. ×

Member journey dashboard

Gain Comprehensive Insights into Member Journeys! Track every touchpoint and interaction across the member lifecycle, providing a holistic view that drives better decision-making. Identify trends, improve service delivery, and increase member satisfaction with detailed, actionable insights. ×

PQI & QIO

Ensure the highest standards of quality care with our Potential Quality Issue (PQI) & Quality Information Organization (QIO) solutions. Automate quality improvement processes, monitor performance metrics, and comply with regulatory standards. Drive continuous improvement in care delivery and outcomes, and maintain excellence in healthcare services. ×

Data scrubber suite

Our Data Scrubber Suite helps you maintain clean, accurate data for all your reporting needs. Automate data scrubbing processes to identify and correct errors, ensuring compliance with regulatory requirements. Improve data integrity, reduce risks, and enhance decision-making with reliable data. ×

GRC Control Center

From fragmented oversight to centralized governance

Say goodbye to silos and outdated files.

Our platform unifies policy, contract, and regulatory documents in one secure place for clear governance. With structured workflows and audit trails built in, teams stay aligned, accountable, and ready for any review

GRC Control Center
Risk & Issue Intelligence

Risk & Issue Intelligence

From reactive tracking to real-time risk response

Connect risks, issues, and CAPs across departments, making it easy to identify patterns, assign ownership, and drive closure

Connect risks, issues, and CAPs across departments, making it easy to identify patterns, assign ownership, and drive closure

Compliance Monitoring Engine

From guesswork to always-on compliance

Automated evidence tracking, role-based workflows, task tracking, and KPI monitoring eliminate the need for last-minute prep, keeping your compliance posture strong year-round.

Compliance Monitoring Engine
Performance & Insights Hub

Performance & Insights Hub

From disconnected data to actionable insights

Leadership dashboards, KPI tracking, and assessment tools turn GRC data into operational intelligence.

Whether it’s monitoring CAP timelines, surfacing overdue risks, or generating reports for executives and regulators, everything is available in real-time, with minimal manual intervention.

Success story

How one health plan transformed its GRC operations

A regional Medicare Advantage plan struggling with policy versioning issues, CAP delays, and disconnected risk tracking turned to Inovaare for a unified GRC solution.

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Reduction in audit prep time
0 %
Faster issue-to-CAP closure
0 %
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Annual cost savings ($)
0 K+
Inovaare-AG-Leadership-monthly-hours-saved
Increase in reporting efficiency
X

Key products

Give wings to your GRC program

Payer-focused GRC platform comprising loosely coupled yet highly cohesive, modular solutions for delivering a unified GRC experience

FAQs

Have questions? We have answers.

Regulatory Compliance

Can I track and manage corrective actions linked to compliance issues?

Inovaare’s platform is built with real-time compliance tracking and pre-configured regulatory logic, enabling health plans to automate documentation, maintain audit-ready records, and avoid non-compliance penalties. It ensures every process—from intake to resolution—adheres to CMS guidelines.

How does the system handle regulatory updates?

Our cloud-based platform includes continuous CMS rule updates and audit templates, so health plans never fall behind on regulatory compliance. These updates are applied automatically, reducing the need for manual configuration or IT support.

Can the platform help me track KPIs across compliance and risk?

Yes. We provide real-time dashboards for key metrics, like CAP turnaround time, policy updates, risk trends, and audit closure timelines.

Technology

Is your GRC platform secure?

Yes. Our platform is HIPAA-compliant, HITRUST-certified, and hosted on secure, scalable cloud infrastructure built for healthcare data.

Can we integrate Inovaare’s GRC suite with our existing systems?

Yes. We provide robust REST APIs and secure data exchange capabilities that integrate seamlessly with your existing systems.

Does Inovaare support no-code or low-code configuration for workflows?

Yes. Our self-service platform empowers users to configure rules, routing, templates, and workflows with no or minimal developer support, reducing IT dependency and increasing agility.

Do you support single sign-on (SSO) and role-based access?

Yes. We support SSO integration and offer granular, role-based access controls across all modules to maintain data security and user governance.

What infrastructure or hosting model does Inovaare follow?

Inovaare is hosted on a secure, scalable cloud-native infrastructure with multi-region backup, automated updates, and 24/7 monitoring. It’s built for performance, reliability, and compliance with industry-leading standards.

Is the GRC platform available for on-premise deployment?

No. Our GRC platform is cloud-native and available only as a SaaS solution. This ensures faster deployment, lower IT overhead, automatic updates, and better scalability—ideal for healthcare organizations looking to modernize without infrastructure burden.

Can the GRC platform be customized to fit our workflows and compliance structure?

Yes. Our GRC platform is built on a flexible, low-code/no-code architecture that allows extensive customization—without writing code. You can configure workflows, forms, rules, notifications, and access roles through a self-service admin console. For more advanced customizations, our support team works closely with you to ensure the platform aligns with your internal processes, regulatory needs, and reporting structure.

Pricing & Implementation

Do I need to purchase all modules upfront?

No. You can start with one or more modules and expand as needed. Our solutions are modular, so you only pay for what you use.

What level of support does Inovaare provide?

We offer end-to-end onboarding, configuration assistance, user training, and ongoing support. Our team ensures smooth adoption and continuous optimization tailored to your compliance needs.

What’s your pricing model?

We offer flexible pricing based on modules selected, number of users, and deployment scale. Both bundled and standalone options are available.

Is onboarding and training included in your services?

Yes. Every implementation includes admin training, user onboarding, and documentation support. We also offer post-launch support and refresher sessions.

How long does it take to implement your GRC suite?

Implementation timelines range from 4 to 16 weeks or more, depending on the scope. Our team handles configuration, integrations, training, and go-live support.

Operations

How does Inovaare’s impact cost efficiency and ROI?

Inovaare reduces the cost to serve by automating labor-intensive tasks, minimizing audit penalties, and improving staff productivity. Most clients experience up to a 67% reduction in compliance-related expenses within the first year, making it a high-ROI investment for financial leaders focused on operational savings.

Does Inovaare require heavy IT involvement post-implementation?

No. The platform is built to empower business users through no-code configuration. IT involvement is minimal beyond initial setup, freeing up technical resources for strategic priorities.

Can different departments use the platform simultaneously?

Yes. Compliance, risk, audit, IT, and operations teams can collaborate through role-based access and shared dashboards, on the same platform.

Does the platform offer any AI capabilities?

Yes. Our GRC suite includes AI Agents designed to streamline audit preparation, document analysis, and task execution. It reduces manual effort, accelerates preparation cycles, and provides audit and compliance teams with a smarter, faster way to stay prepared.

Is the system scalable for multi-state or enterprise-level GRC operations?

No. The platform is built to empower business users through no-code configuYes. Whether you’re a regional plan or a national payer, our platform supports enterprise scalability, multi-region operations, and complex role hierarchies.ration. IT involvement is minimal beyond initial setup, freeing up technical resources for strategic priorities.

Explore our AI-driven healthcare solutions

Struggling with compliance burdens, operational delays, or data gaps?

Discover how Inovaare’s SaaS-based payer solutions, built on its AI-powered platform,
help health plans streamline processes, reduce risk, and improve member outcomes.

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