Risk assessment, continuous monitoring, audit prep, investigation, and corrective action — the OIG compliance lifecycle, operationalized from the claims feed you already have. RADV-ready. OIG-aligned. CCO-defensible.
Manual compliance monitoring doesn't scale. Auditors move faster than spreadsheets.
You learn about compliance gaps when the audit letter arrives. By then, you're assembling documentation under deadline pressure and explaining patterns you didn't know existed. CMS RADV audits are expanding in scope and frequency.
When auditors ask "how do you monitor for X?", you need to show process documentation, detection logic, and historical evidence. Building this retroactively is painful.
Claims data lives in your data warehouse. Provider info is in credentialing. Audit findings are in spreadsheets. Without a unified platform, you can't build predictive models or create feedback loops that improve over time.
You know RADV audits are a continued OIG priority, but you don't know which providers or HCCs are most likely to be sampled—or which may have the most documentation risk.
Monitoring individual provider compliance across your network is a full-time job—or several. OIG compliance guidance expects organizations to have effective monitoring systems in place.
CMS updates, OIG work plans, state-specific requirements—the compliance landscape shifts constantly. Keeping your monitoring current is a moving target.
Continuous monitoring and audit-ready documentation that proves you're doing the work.
Automated surveillance of claims patterns, coding accuracy, and billing compliance. Know about issues before auditors do—not after.
One-click generation of documentation packages for RADV, OIG, CMS, and state audits. Complete with detection logic, findings history, and remediation tracking.
Identify which HCCs and providers are most likely to be sampled and which may have the most documentation risk. Prioritize pre-audit remediation.
Individual compliance scores for every provider in your network. Coding accuracy, billing patterns, and flagged issues—all in one view.
Pre-built outlier detection for common compliance requirements plus the ability to configure thresholds for your specific policies and risk areas.
Ask questions in plain English and get answers from your compliance data. AI-powered investigation without writing queries.
Track every finding from detection through investigation, remediation, provider education, and verification. Element 7 of OIG's framework, operationalized — so when regulators ask "what did you do about it?", you have a defensible answer.
See how Pamastay gives your compliance team continuous monitoring and documentation that proves you're doing the work.