Universe Management System (UMS)

Streamlining CMS Program Audits with Inovaare’s Universe Management Suite

• Automated the collection, review, and submission of audit universes through Inovaare’s Universe Management System (UMS)
• Centralized data management for efficient and accurate universe generation
• Improved compliance monitoring and audit readiness with Timeliness Dashboards
• Significant reductions in audit review time and external audit costs

Quantifiable Results

The client is a Fortune 500 health plan that serves Medicare and Medicare-Medicaid (MMP) members nationwide. The health plan is dedicated to delivering quality healthcare services while maintaining compliance with stringent CMS requirements.

• Before implementing Inovaare’s Universe Management Suite, the health plan faced significant challenges:
• Manual Processes: Compliance and audit teams relied on labor-intensive manual processes, leading to inefficiencies and errors.
• Resource Drain: The manual preparation of CMS universe submissions consumed vast amounts of time and resources, increasing compliance risks and operational costs.
• Inaccurate Reporting: The lack of automation resulted in unreliable reporting, redundant efforts, and inflated costs.

The health insurance provider adopted Inovaare’s Universe Management System (UMS) to enhance their audit and compliance processes. Their specific goals included:

• Automate Compliance Processes: Streamline the CMS Program Audit preparation by automating universe management tasks.
• Enhance Reporting Accuracy: Ensure accurate and timely universe submissions to CMS.
• Reduce Costs: Decrease the expenses associated with audits and compliance through efficient, automated processes.

“When we started scrubbing, we had 10,000–15,000 error counts. We significantly cut down the error count and drastically improved our ability to submit CMS-compliant universes quickly. Inovaare’s Universe Management solution has exceeded our expectations in every way. We are particularly impressed with the accuracy and reliability of the findings on universe errors.”

After evaluating multiple vendors, the health plan selected Inovaare’s Universe Management Suite for its robust capabilities:

• Automated the validation and correction of universe tables, significantly reducing manual errors.
• Continuous monitoring and early issue detection enabled proactive management of compliance risks.
• Built-in CMS compliance rules allow for quick configuration of customer-specific rules, reducing the risk of non-compliance.
• Timeliness dashboards provide real-time visibility into data outliers, enhancing preparedness and compliance monitoring.
• The UMS consolidates data from multiple sources, ensuring efficient and accurate universe files for consistent compliance monitoring and audit reporting. This enables data-driven decisions and better audit outcomes.

The implementation of Inovaare’s Universe Management System (UMS) has provided the health insurance provider with unprecedented levels of efficiency and accuracy in their audit processes, leading to numerous benefits:

• Automated processes reduced manual effort and enabled faster, more accurate audits.
• Continuous monitoring and error detection ensured consistent compliance with CMS requirements.
• The health plan experienced substantial reductions in external audit costs and internal resource allocation.

The health plan saw measurable improvements across several key areas:

• Audit Review Time: Reduced by 90%, allowing teams to focus on strategic initiatives.
• Cost Reduction: External audit costs decreased by 67%, resulting in significant savings.
• Compliance Success: Achieved a 100% success rate in passing CMS audits on the first submission.