Begin Audit Planning the Right Way by Creating the Right Audit Universe
CMS audits utilize various universes-CDAG, ODAG, SARAG, CPE and other regulatory reports-to evaluate health plan performance. Despite current innovations, it has been a constant challenge for health plans to create and submit accurate, timely universes to avoid invalid data submissions and poor audit scores.
In fact, many organizations still rely on time-consuming manual processes, which are often riddled with errors, inconsistencies or both. However, by automating the process, health plans can be better prepared to generate and validate accurate, clean universes that are ready for submission and, as a result, improve their operational efficiency for a healthier bottom line.
UNIVERSE GENERATION
lnovaare’s Universe Generation module can be pre-built for report generation at the touch of a button, with each report in the approved format for layout and data type. As an additional benefit, compliance teams will no longer need to wait for IT request fulfillment, which often takes days.
Universe Generation automates the query process so compliance teams can sustain a state of audit readiness at all times, when it’s utilized for routine monitoring. By expediting report turnaround times-while reducing the risk of penalties and low star ratings-Universe Generation offers a significant return on investment. It pays to be proactive.
KEY FEATURES
- Complete ODAG and CDAG universes listed
- Preconfigured business rules per regulatory mandates, with additionalc onfiguration available for company-specific business rules
- Automated analytics generate intuitive executive dashboards and KPI reports
A universe failure can drastically affect your audit score, could lead to a referral for possible enforcement actions or adversely affect your ratings. However, the effort required to generate accurate and compliant CMS Universes is so high that most health plans do not routinely utilize them as an ongoing compliance tool.
Pravat Rout,
CEO & Founder lnovaare Corporation
UNIVERSE SCRUBBER
This cloud-based module scrubs reports for authorizations, claims, and appeals and grievances on demand to validate universes in real time. The plug-and-play solution with embedded standard-business rules is ready for use with no installation requirements.
Universe Scrubber also promotes transparency and control by offering configurable methods to strategically plan audits. Delegated entity reports can be validated-by establishing business rules to identify any outliers-and consolidated into the final report for submission
EXPECTED BUSINESS OUTCOMES
- Lower administrative costs = Improved operational efficiency
- Early error identification = Reduced rework requirements
- Real-time analytics = More effective oversight and governance