In the Fields of Universe Management, Compliance Favors Only the Prepared Plan Louis Pasteur famously said, “In the fields of observation, chance favors only the prepared mind.” But why leave anything to chance? By applying real-time compliance systems to Appeals and Grievances processes, health plans will quickly discover they can proactively manage their universes and sustain continuous ODAG and CDAG readiness with the touch of a button. Utilize Universes Beyond Audits • Be known by the universes you keep • Use universes like the CMS and uncover pathogens hidden in your data • Apply universes as your Delegated Entity score card

1. Compliance Favors Only
the Prepared Plan
Why leave anything to chance?

2. Why leave anything to chance?
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Compliance Favors Only the Prepared Plan
Louis Pasteur—the French
microbiologist and chemist who
discovered the principles of vaccination,
microbial fermentation and
pasteurization—is also famed for saying:
“In the fields of observation,
chance favors only the
prepared mind.”
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3. Pathogens in data go unnoticed until something pops … and it’s not a tasty snack
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Traditional Practices Have Unpredictable Outcomes
ODAG and CDAG programs without
real-time monitoring—and a system
to house the data—can fall prey to
health-plan pathogens such as:
› Chaotic universes
› Untimely notifications
› Inappropriate denials
› Increased expenses
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4. Master the universe and comply with the world
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Paradigm Shift
› Proactively manage universes
› Uncover pathogens hidden in your data
› Always ensure audit readiness
› Leverage real-time data
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5. Apply Universes Beyond Audits

6. This ain’t your granddaddy’s monitoring system
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Utilize Universes Beyond Audits
› Use universes like CMS
› Uncover pathogens hidden in your data
› Be known by the universes you keep
› Leverage real-time data
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7. OMG! Did I just total my audit score?!
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Use the Windshield, Not the Rearview Mirror
› Member harm
› Civil monetary fines
› NONC
› Enrollment freezes
› Denial of network expansions
› Lower star ratings
› Additional audits
› CARs and or the dreaded ICARS
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8. Be Known By the Universes You Keep

9. You don’t have to be a Carpenter to be a Superstar
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Be Known by the Universes You Keep
Real-time monitoring ensures:
› Early identification and correction
› Continuous compliance
› Effective controls
› Completed transaction processing
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10. And pasteurize the pathogens or risk ingesting nasty data
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Build Upon a Compliant Foundation
› Harness the data in your systems
› Prevent old data from becoming toxic
› Centralize real-time data
› Support seamless collaboration
› Ensure real-time risk identification
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11. What your system doesn’t say may cost you
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Silence Is Complicity
› Interest paid on claims processed
within expected timeframes
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› What if your system can alert
you on case #2, not #68?
• Utilize your existing tools
• Monitor processes
• Observe what’s happening
Now consider this:

12. Take the road less traveled and experience all the difference
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Could This Be Your Robert Frost Opportunity?
Hope
› Generate a clean universe without traditional infrastructure
› Create CMS universes on demand in real time
Vision
› View your plan like the CMS sees it
› Detail how to improve your compliance program
Options
› Build it yourself
› Hire consultants
› Leverage technology
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13. Avoid the eternal answer: I don’t know
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Oh, The Eternal Question
› Know your status at any given moment
› Create a centralized repository
› Identify outliers in real time
› Automate notifications
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14. Thank You
For more info please feel free to reach out to :
Brenda Wade, Compliance Officer Gabriel Viola, SVP Client Relations
brenda.wade@inovaare.com gabe.viola@inovaare.com
(562) 225-2881 (805) 990-3637
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@ 2020 Inovaare | All rights reserved Company confidential