Because of our experience in managed care, we are the ideal consultants to help your organization design operational processes and infrastructures. We take a close look at your operational policies, documenting and reviewing them with regulatory requirements in mind, to ensure compliance with the requirements of concerned federal and state agencies.

Compliance Strategies consultants have developed and managed numerous aspects of government programs including, but not limited to:

• Regulatory compliance
• Enrollment and marketing
• Member services
• Complaints, grievances, and appeals
• Network development and contracting
• Claims processing
• Health services, including utilization management and case management

• Flexible options – As a small consulting team, Compliance Strategies has the flexibility to assist in developing what you need. Some clients are looking for assistance with developing an operational department from planning to hiring staff.  Others just need assistance with developing specific workflows.

• Project management – For larger initiatives, consultants are available to develop and manage projects, thereby ensuring the desired outcome is achieved.  The critical path is continuously monitored, with the project manager escalating potential issues to minimize risks.

• Material development – Government programs have strict requirements related to material content and approval prior to implementation; whether it’s a mandated member brochure like a Summary of Benefits or Member Handbook or a Service Authorization or Referral Form for providers, we’re here to translate your rules into standardized materials that comply with government requirements, ensuring a speedy approval. 

• Training and training material development – Compliance Strategies has leveraged its health care experience and its background in adult learning to solve the training challenges facing health plans.  Facilitated workshops are just the beginning. Compliance Strategies has developed computer-based training material, self-study guides, and on-the-job coaching programs.

• Measuring results – How do you know a process is working?  Consultants can help develop baseline measures and create reports to ensure that performance is accurately reflected and that potential risks are identified and corrected timely.