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Regulatory Management Module

Regulatory compliance management across CMS, NCQA, and state requirements including filing calendars, submission tracking, and compliance status.

4
Pages
4
API Endpoints
5
High-Priority Orgs
5
Requirements

Organization Relevance

MCO: High Health Plan: High TPA: High ACO: High FQHC: High IPA: Medium PHO: Medium MSO: Medium

How It Works

The regulatory module maintains a comprehensive calendar of filing deadlines across all applicable regulatory bodies. Each requirement is tracked from preparation through submission and approval. CMS-specific workflows manage Medicare Advantage and Medicaid reporting. NCQA accreditation tracking ensures standards compliance. State regulatory requirements are tracked by jurisdiction.

Requirements

  • Regulatory calendar maintenance
  • Filing preparation workflow
  • CMS portal integration (HPMS, MARx)
  • NCQA standards mapping
  • State filing requirement database

Target Audience

Regulatory Affairs, Compliance Officers, Quality Directors, Legal Teams

Pages (4)

PagePurposeKey Features
Regulatory Calendar Master calendar of regulatory deadlines and filing requirements Calendar view, Deadline tracking, Owner assignment, Alert notifications
CMS Compliance CMS-specific regulatory requirements and filing management CMS requirements, Filing preparation, Submission tracking, Response management
NCQA Accreditation NCQA accreditation standards tracking and evidence management Standards mapping, Evidence collection, Gap analysis, Survey preparation
State Regulations State-level regulatory requirements by jurisdiction State requirements, Filing tracking, Jurisdiction management, Compliance status

API Integrations

  • CMS HPMS API
  • Regulatory calendar API
  • Filing status API
  • Compliance tracking API

Referenced Resources

  • CMS Medicare Advantage Requirements
  • NCQA Standards and Guidelines
  • State DOI Filing Requirements
  • ERISA Regulatory Guidance

Expected Results

On-time regulatory filings, accreditation maintenance, and proactive compliance management across all jurisdictions.