Health Plan Consulting for UM Compliance, Delegation Oversight & Audit Readiness
We strengthen UM operations, vendor oversight, appeals workflows, and audit artifacts so your program is defensible, consistent, and scalable.
Problems We Solve
- Delegated UM oversight gaps (inconsistent evidence, weak monitoring cadence)
- Timeliness, notice language, and documentation inconsistencies
- Appeals/grievance workflow weaknesses and poor standardization
- Audit risk due to missing artifacts and unclear governance
- Operational variability across vendors, MSOs, IPAs, and internal teams
What We Deliver
Engagement Offers
UM Compliance Gap Scan (10 business days)
Map policy → operations → evidence. Deliver prioritized corrective actions.
Delegation Oversight Build-Out (30–60 days)
Scorecards, governance cadence, audit tools, and operational controls.
Audit Prep Sprint (2–4 weeks)
Rapid artifact build, mock audit, and staff readiness training.
KPI Examples We Help Establish
- UM timeliness performance (by service type)
- Appeal overturn rates and root causes
- Provider abrasion indicators (peer-to-peer cycle time, complaint drivers)
- Delegated entity scorecards and corrective action closure rates
Contact Us
Build a defensible UM program with evidence that holds up.
Request a scope and deliverables list.