Managed care reporting is high-stakes, high-complexity — and rarely well-supported.
Compliance Risk
Filing errors carry serious regulatory and financial consequences. Deadlines shift, requirements vary by state, and the margin for error is slim in a scrutinized environment.
Operational Drag
Manual workflows consume expert capacity that should be directed toward strategy. When your best analysts are buried in spreadsheets, your organization falls behind.
AI Gap
Most teams know AI can help — few know how to implement it safely in compliance contexts. The risk of getting it wrong is too high to experiment without expert guidance.
Six Ways We Support Your Reporting Function
MLR Compliance & Filing Support
End-to-end support for medical loss ratio calculations, reporting, and regulatory submission.
Medicaid Managed Care Reporting
Expert guidance on encounter data, managed care reporting, and CHIP compliance requirements.
Cost Report Preparation & Review
Accurate preparation and rigorous review of hospital and health plan cost reports.
AI & Automation Implementation
Safe, compliant deployment of AI tools that reduce manual burden without introducing regulatory risk.
Training & Staff Development
Structured programs to upskill reporting teams on regulatory requirements and modern tools.
Audit Readiness & Remediation
Pre-audit assessments, gap remediation, and representation support for CMS and state reviews.
Deep regulatory expertise.
Modern execution.
We are a boutique consulting firm specializing in managed care reporting, regulatory compliance, and healthcare data operations. Founded by practitioners with direct regulatory experience, we bring technical depth and operational know-how to every engagement — helping health plans, managed care organizations, and their vendors navigate the full complexity of modern reporting requirements.
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As CMS tightens scrutiny on medical loss ratio reporting, health plans are under mounting pressure to improve accuracy, reduce rework, and demonstrate a credible audit trail. Here's what executives need to know heading into the 2025 filing cycle.
New CMS Encounter Data Requirements: A State-by-State Breakdown
Updated submission standards are creating compliance gaps across multiple states.
Can AI Write Your Cost Report? What's Safe and What Isn't
A practical framework for applying AI tools to regulated healthcare reporting.
Why Your Reporting Team Keeps Reinventing the Wheel
Structural fixes that eliminate recurring errors and rebuild institutional knowledge.
Five Signs Your Organization Isn't Ready for a CMS Audit
Early warning indicators — and a remediation roadmap for each.
The Managed Care Reporting Maturity Guide
How leading health plans are modernizing compliance operations in the age of AI
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The Managed Care Reporting Brief
Monthly insights on regulatory compliance, MLR, Medicaid reporting, and AI for healthcare finance teams.