Compliance Excellence

Stay Compliant, Stay Competitive

Healthcare payers operate in one of the most heavily regulated environments in any industry. Non-compliance with CMS, HIPAA, ACA, or state insurance requirements can result in financial penalties, enrollment sanctions, and reputational damage. Hetasalvation's compliance specialists help health plans build and maintain robust compliance programs.

From Medicare Advantage compliance to HIPAA security assessments and state regulatory filings, we provide the expertise to stay compliant — and the monitoring to stay ahead of regulatory changes.

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Compliance Services

Health Plan Compliance Programs

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Medicare Advantage Compliance

End-to-end CMS compliance support for Medicare Advantage and Part D plans — from annual bid submissions to ongoing monitoring of CMS requirements.

CMS regulatory monitoring
Annual bid preparation support
Model of Care development
CMS audit preparation (CPEI, MAPD)
Part D compliance program

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HIPAA Compliance

HIPAA Privacy and Security Rule compliance programs — risk assessments, policy development, workforce training, and breach response planning.

HIPAA risk assessment
Privacy & Security policies
Workforce HIPAA training
Business associate management
Breach notification procedures

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ACA Compliance

Affordable Care Act compliance for commercial and exchange plans — metal tier benefit design, essential health benefits, and MLR reporting.

EHB benefit compliance
MLR calculation & reporting
Risk Adjustment / EDGE reporting
Summary of Benefits & Coverage
Exchange plan filing support

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Compliance Audits & Mock Audits

Internal compliance audits and CMS mock audits that identify vulnerabilities before regulators do — with corrective action planning included.

Internal compliance audits
CMS Program Audit mock audits
Corrective Action Plan (CAP) development
FDR oversight audits
Delegation oversight reviews

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State Regulatory Compliance

State insurance department filing requirements, form approvals, network filing, and ongoing regulatory reporting across all states of operation.

State insurance filing support
Network adequacy filings
Form and rate filing
State audit response support
Multi-state regulatory calendar management

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Compliance Training & Education

Annual and ongoing compliance training for FDRs, delegates, and staff — General Compliance, Fraud, Waste & Abuse, and role-specific training.

Annual GC / FWA training programs
New hire compliance orientation
FDR compliance training
Code of conduct training
Compliance hotline management

Regulatory Compliance