Compliance

Be a Compliance Champion

Government-sponsored health plans are challenged every day with changing rules and regulations from both the state and federal government. These rules can number in the thousands. And when only a handful are relevant, the task of vetting these rules is daunting – especially when CMS issues weekly, sometimes daily, change notices.

Compliance directors are responsible for ensuring materials meet regulatory compliance. Failure to do so could have serious consequences: incurring exorbitant expenses to correct erroneous material, or even facing the risk of being shut down for falling out of CMS’s good graces.

With Our Compliance Consulting Services, You Achieve:

  • Better collaboration between departments. We evaluate, plan and implement workflow and process improvements to ensure the compliance and marketing communications departments work together.
  • Quick and easy tracking and reporting on compliance issues. The Regulatory Analyzer® by CodySoft® provides one location to easily search for relevant CMS and state rules and regulations. And when integrated with the Collateral Management Module®, the Regulatory Analyzer® reports regulatory rules relevant to every piece of collateral material in production.
  • Improved risk management. We conduct a compliance audit to identify areas of risk and provide a risk assessment to mitigate potential issues.

Our Services

Policies, Procedures and Standards of Conduct
  • We develop and implement…
  • Operational and compliance workflows and policy documents
  • Policies and procedures required by federal regulatory agencies
  • Policies and procedures to meet Medicaid contract requirements
  • Code of Ethics and Standard of Conduct documents
Compliance Program Oversight
  • We develop compliance organization strategy, design, and infrastructure. And we recruit experienced compliance leaders and staff.
Training and Education
  • We design compliance training and education programs.
Compliance Program Communication
  • We develop…
  • Protocols and tools that track and convey internal compliance communications
  • Workflow designs to intake, disseminate, track and manage regulatory communications-including HPMS memos
Monitoring, Auditing and Identification of Compliance Risks
  • We conduct…
  • Compliance program risk assessments and ongoing monitoring of compliance risks
  • Compliance audits and CMS mock audits to ensure CMS standards are met
  • Risk assessments and audits to Medicaid contracts
  • Operational department audits to ensure compliance standards are met
  • Delegated vendor audits against contractual requirements
  • We also design corrective action plans.
Compliance Investigations and Incident Management
  • We evaluate sales and marketing operational effectiveness, including sales agent oversight. And, we design formal disciplinary standards and incident management processes.
  • We also conduct…
  • Compliance investigations of suspected violations of corporate policy, contracts, rules and regulations
  • Evaluations of suspected marketing regulation violations, including CMS and CTMs
  • General corporate investigations and training