Comprehensive healthcare compliance solutions tailored to your organization's needs
Navigate the complex landscape of Centers for Medicare & Medicaid Services regulations with expert guidance and comprehensive support for Medicare Advantage, Part D, and Medicaid programs.
Ensure your organization meets all CMS Conditions of Participation requirements for Medicare and Medicaid certification and reimbursement.
Comprehensive compliance support for MA and Part D plans including enrollment, marketing, member communications, and Stars ratings improvement.
Navigate MIPS, Hospital Quality Reporting, and other CMS quality measurement programs with confidence and accuracy.
Expert support for CMS audits, program audits, and corrective action plan development and implementation.
California-specific healthcare compliance expertise for Medi-Cal managed care plans and health plans regulated by the Department of Managed Health Care.
Full-service compliance support for Medi-Cal managed care plans including contract requirements, network adequacy, and quality improvement.
Prepare for and respond to DMHC routine and targeted surveys, including full-service and specialized health plan requirements.
Ensure compliance with enrollment procedures, member communications, provider network management, and operational standards.
Develop and maintain compliant grievance and appeals processes that meet both DHCS and DMHC requirements.
Achieve and maintain National Committee for Quality Assurance (NCQA) accreditation for health plans, medical groups, and patient-centered medical homes.
Comprehensive support for NCQA Health Plan Accreditation including commercial, Medicaid, Medicare, and multi-product accreditation pathways.
Expert guidance on HEDIS measure reporting, data validation, quality improvement strategies, and Stars rating optimization.
Achieve Patient-Centered Medical Home (PCMH) recognition with support for practice transformation and documentation requirements.
Gap analysis, policy development, and operational readiness to meet NCQA standards across all required elements.
Schedule a consultation to discuss how our services can support your organization's compliance goals.