Compliance that holds up to regulators and works for your operations
Regulators do not grade on effort. They look for a program that is documented, operating, and producing evidence. BeeReady helps health plans, Coordinated Care Organizations, health systems, provider groups, and delegated partners build compliance programs that satisfy CMS, state Medicaid agencies, and state insurance regulators while fitting the way your teams actually work. Every engagement is led by a former Chief Compliance Officer who has sat on your side of the audit table.
Schedule a conversationSound familiar?
These are the situations that bring health plans, provider organizations, and their partners to BeeReady.
- A CMS program audit notice, state readiness review, or regulator inquiry has arrived and the evidence lives in a dozen inboxes.
- A new rule, CMS memo, or state contract amendment is in effect and no one owns the operational impact.
- Your compliance program has never been independently assessed, or the last assessment produced a report that gathered dust.
- Findings keep repeating because corrective action plans fixed the symptom and not the root cause.
- You are a delegate or provider organization, a health plan client has audited you, and the corrective action plan is due.
Six ways we help
Compliance program effectiveness assessments
We measure your program against the seven elements, HHS Office of Inspector General compliance program guidance, and CMS Medicare Advantage program audit expectations. You receive a risk-ranked roadmap with owners and timelines, not a list of observations.
Regulatory assessment and implementation
We translate final rules, CMS guidance, and state contract changes into operational requirements: who owns them, which policies and systems change, and what evidence proves it was done.
Mock audits and audit readiness
Full simulations of CMS program audits, including Compliance Program Effectiveness, Organization Determinations, Appeals and Grievances, Coverage Determinations, Special Needs Plan Model of Care, and Formulary Administration, plus state Medicaid readiness reviews. We pull universes, sample cases, run tracers, and prepare your staff for interviews.
Corrective action and remediation
Root cause analysis, corrective action plans written the way regulators expect to read them, and validation testing that proves the fix held.
Privacy and HIPAA program governance
Privacy program assessments, incident response and breach risk assessment processes, business associate oversight, and workforce training that people complete and remember.
Mental health parity
Nonquantitative treatment limitation comparative analyses, operational data testing, and regulator response. Parity is a dedicated practice at BeeReady; see the Mental Health Parity page for the full service.
BeeReady is led by a former Chief Compliance Officer with more than 15 years of executive health plan experience across Medicare Advantage, Medicaid, Commercial, Federal Employees Health Benefits, and Exchange lines of business. We have built compliance programs from a blank page, remediated programs under regulatory scrutiny, and prepared plans for CMS program audits. We know which questions auditors ask first and what a defensible answer looks like.
What you walk away with
Typical deliverables
- Compliance program gap assessment with a risk-ranked remediation roadmap
- Mock audit report written in CMS condition language, with impact analysis
- Corrective action plans with root cause documentation and validation test plans
- Policies, procedures, and training content for the areas in scope
- Audit response playbook and evidence inventory your team can reuse
Before you call
Do you work with vendors and delegated entities, or only health plans?
Both. First tier, downstream, and related entities face the same CMS and state expectations as the plans that delegate to them, and the plans will audit for it. We help vendors build programs that satisfy their upstream clients and help plans evaluate the vendors they rely on.
How is this different from your outsourced compliance service?
Compliance and Regulatory engagements have a defined start and finish: an assessment, a mock audit, a remediation effort. Outsourced and Fractional Compliance is ongoing coverage of your compliance function. Many clients start with an assessment and move to ongoing support once they see the gaps.
Find out where you stand before a regulator tells you
Tell us what prompted the call: an audit notice, a new requirement, a finding that will not close. We will tell you what we would do first.