Are You Managing Your Compliance Program Effectively?


Taking the time to develop a robust compliance program for your health plan is a given necessity if you wish to operate ethically and with integrity. In addition to avoiding penalties for non-compliance, a truly effective program will help you create a competitive edge, leading to enhanced benefit offerings, improved member retention, and membership growth. Particularly this time of year, when you are preparing for Annual Enrollment Period (AEP) marketing, new enrollees, and managing the intake and implementation of new Centers for Medicare & Medicaid Services (CMS) requirements and memorandums.

Key Elements of a Vigorous Compliance Program

If your health plan is dedicated to building a solid reputation and achieving strong ratings, your healthcare compliance program should have these three critical elements:

      • A culture of compliance where management supports and engages the company’s efforts, and where employees from the entire organization are committed to these efforts. 
      • A well-organized and well-established compliance team with the ability to interpret and understand CMS program requirements, and demonstrate preventive measures to react to and implement changes. 
      • A robust monitoring solution that allows you to effectively manage your compliance program and navigate through the turbulent regulation landscape without fear or risk.

Minimize Risk & Reduce Shortfalls in Meeting CMS Standards

Convey Health Solutions (Convey) offers to health plans with a keen focus on compliance adherence, Online Monitoring Tool, or OMT. With seven different modules to help you manage your adherence to CMS program requirements, the Convey OMT toolkit streamlines critical activities that often rely on manual documentation and distribution so you can oversee your own compliance with Medicare Advantage and Part D regulations. You have the ability to make informed decisions for necessary business improvements that will reduce the risk of CMS compliance actions, material financial loss, or damage to your organization’s reputation.

Plan experts who are compliance-focused and directed maintain our toolkit. These experts support the functions and processes that compliance departments struggle with the most:

      • Identifying and addressing risk areas
      • CMS audit preparedness
      • Regular internal auditing
      • Creation and implementation of corrective action plans (CAPs)
      • Addressing regulatory actions, such as Health Plan Management System (HPMS) memos
      • Tracking marketing and member materials with version controls

The OMT Materials, Notices and CAPs modules were designed to alleviate the competing demands faced by compliance departments and address those areas that present the highest perceived risk of non-compliance. Below is a brief snapshot of these three modules.

Download our AEP-related compliance checklist and compare OMT's functionality  with what you currently have in place.

Track your marketing and member materials with version controls
With Materials, you can create and track internal review and CMS submission of materials and communications, and auto-generate unique material IDs. Materials also allows for easy review and reference using a single location for storing and tracking information and documentation related to each record. There is a lot to manage to ensure your materials are compliant in the eyes of CMS, and that your organization is represented accurately to current and prospective beneficiaries.

A repository for your notices and related actions
Notices allows you to load automatically the significant volume of HPMS and other notifications for easy tracking and storage. System generated emails notify users of record and task assignment, and the Notices module provides a single location to store and view all notices and related actions.

Create and implement corrective action plans
Your team can use the CAPs module to manage and track correct action plans with email reminders as items approach their due date. Records and tasks are assigned to individual system users to monitor through completion. The module also allows you to track records and view trend reports.

Download OMT AEP Checklist

As an integrated healthcare compliance software solution that supports your entire organization, OMT also offers these additional modules:

      • Audits–For CMS audit preparedness and regular internal auditing, Audits offers complete flexibility. You can audit one requirement, a complete part of a process, or mirror CMS.
      • Elements–This provides a centralized location to link supporting documents, policies, records to evidence compliance, and a repository for monitoring adherence to service level agreements, contracts, and any other requirements you wish to capture (NCQA, Medicaid, etc.).
      • Events–A customized work-ticket module that offers the versatility to track almost anything: potential compliance issues, FAQs, sales allegations, and more.
      • Indicators–With Indicators, you can report customized metrics on a monthly, quarterly, or annual basis. It offers dedicated dashboard tracking and a link to internal or CMS requirements to evidence compliance throughout the organization.

Are you confident in your health plan’s ability to prevent exposures that could place it at risk?
The OMT compliance toolkit brings flexibility and a high level of transparency to performance monitoring and ongoing auditing. To learn more about streamlining and elevating your compliance management solution today, visit or give Andrew a quick call. He can help you identify the areas where OMT can be deployed and begin effectively managing your compliance activities today!
Andrew Ryan: 786.376.4473,

Don't forget to take our checklist back and inventory what streamlined  functionality you currently have in place!