The AI Compliance Platform for Health Plans to Protect Revenue and Lower Costs
Margins are shrinking. Regulatory scrutiny is increasing. Our AI solutions automate member operations, audits and regulatory management, helping to preserve margins while protecting you from regulatory risk.
Trusted by health plans across Medicare Advantage, Medicaid and Commercial lines of business
The Challenge
Health plans are running compliance operations across disconnected systems.
Audit Findings That Could Have Been Prevented
Repeat deficiencies signal governance failure to CMS. Most findings trace back to evidence gaps, missed deadlines or disconnected corrective actions.
Compliance Ops That Don't Scale
A&G cases, universe files, CAPs and delegate audits all growing 15%+ year over year. Manual workflows force you to add headcount just to keep pace.
Tools That Don't Talk to Each Other
A&G in one system, audits in another, CAPs in a spreadsheet, delegation in email. Every handoff between tools introduces delay, data loss and audit risk.
Introducing AI Agent Studio
Deploy a pre-built AI agent pilot or build one from scratch.
Intake classification, regulatory tracking and audit prep consume the hours your team needs for higher-value work. Deploy pre-built agents for those workflows today, or build custom agents for any use case.
AI Built Into Every Module
Usher AI assistants work inside every module. Document analysis, intelligent search, conversational dashboards and workflow automation available wherever your team works.
- Guided task execution across all modules
- Document analysis and data extraction
- Knowledge search across compliance data
- Conversational reporting and dashboards
Pre-Built Agents for Payer Workflows
- Appeals & Grievances intake and routing agents
- Regulatory tracking and policy reasoning agents
- Delegation oversight and FDR review agents
- CMS program audit and mock audit agents
Start with pre-built agents or build your own. Pilot with clear ROI targets. Scale on your results.
Platform Modules
Solutions built for every team.
Multiple modules across teams, grouped by who uses them. Every module shares data across the full platform.
- Usher AI
AI intelligence built into every module.
Usher AI is Inovaare’s embedded intelligence layer, purpose-built for healthcare payers. It augments decision-making while keeping your team firmly in control.
Customer Outcomes
What health plans achieve
with Inovaare.
Audit Readiness
Regulatory Compliance
Audit Readiness
Compliance Operation
By the Numbers
Real outcomes. Compliance and operational.
Measured across Medicare Advantage, Medicaid and commercial health plans in compliance rigor and operational efficiency.
The Regulatory Library module tracks federal, state and CMS updates year-round with impact analysis and workflow triggers built in.
Universe preparation and Part C&D report cycles reduced from 6-8 weeks to under one week with automated validation.
Corrective action plans close up to 3x faster with closed-loop tracking, reducing consultant dependency and recurring findings.
Why Inovaare
Purpose-built for Health plans. A platform that knows your regulatory environment as well as you do.
Most compliance platforms were built for financial services or general enterprise use, then loosely adapted for healthcare. Inovaare was built from day one for U.S. healthcare payers.
FAQ
Questions health plans ask
about Inovaare.
Inovaare is an AI-native, integrated compliance operation platform for healthcare payers. It automates the full compliance lifecycle — from Appeals & Grievances and Universe Management to Corrective Action Plans and Delegation Oversight — for Medicare Advantage, Medicaid, and commercial health plans. The platform includes 18 modules that share data natively, replacing fragmented spreadsheets and point solutions with a single, continuously audit-ready system.
Inovaare is purpose-built for Medicare Advantage (MA), Medicaid and Medi-Cal managed care organizations, commercial health plans, and partners including PBMs, MSOs, MCOs, and TPAs. Unlike generic platforms, its modules are pre-configured for CMS workflows, including ODAG, CDAG, SARAG, MPDSF, and HPMS Part C and D reporting.
Yes. The Inovaare Health Cloud Platform is HIPAA-compliant and HITRUST certified. All data is processed in a secure, audit-logged environment with role-based access controls.Â
Usher AI is Inovaare’s embedded intelligence layer. It automates evidence mapping, audit sampling, policy interpretation, and workflow routing across all 18 modules. Usher AI operates with human-in-the-loop validation — compliance teams retain final review and approval authority over every critical decision. It is not a standalone AI tool; it is infrastructure built into every module.
Yes. Inovaare is a low-code / no-code platform designed for business users. Compliance and operations teams configure workflows, validation rules, scrubbers, and reporting thresholds directly — while IT retains governance over security, access controls, and infrastructure. New CMS rule changes can typically be deployed in days, not quarters.
Our Value
Delivering measurable outcomes
We transform your healthcare operations, helping you save hours on audit-related documentation and reporting. Achieve significant compliance-related cost savings and ensure timely, accurate regulatory submissions.Â