Compliance Reporter

A robust reporting and workflow management tool for payers that want to streamline and increase their Healthcare Effectiveness Data and Information Set (HEDIS®) quality measurement and reporting activities.

Amplify Your HEDIS Activities

Simplify the complete hybrid review process through our NCQA-certified HEDIS quality rules processing engine. Generate samples, manage medical record abstractions, and create data submission files.

Eliminate time-consuming manual coding and measure updates with automated processes. Certify final hybrid rates within minutes, rather than days.

Support medical record review activities with online and offline data collection. Central data repository holds claims, membership, enrollments, lab, and pharmacy data, plus scanned charts.

Increase efficiency throughout the HEDIS lifecycle. Create your CAHPS® survey sample frame in a few clicks. Manage both your HEDIS and analytics drawing from the same input files, with Risk Manager.

Use web-based workflows to allocate chart reviews manually or systematically by location. Isolate measure-level and member-level detail for further research using powerful audit tools.

Receive up-to-the-minute results with in-line rate calculation. Quickly generate NCQA IDSS data files, the CMS-required PLD submission file, and Medicare patient-level data for final submission.

Simplified Collection, Review, Submission, and Reporting

Systematic medical record review

  • Improve data integrity with a centralized data repository, updated with the latest compliance details. Manage the entire medical record review process with single-source, clean data.
  • Streamline chart review with web-based workflows, including management chart review and chart chase management. Flexible task assignments accommodate various workflows to speed the process.
  • Stay on track with HEDIS process productivity summary, which includes measure status and a tally of remaining/completed charts by reviewer. Validate full compliance and exclusion reports from external reviewers. 

Comprehensive NCQA-specific reporting

  • Receive up-to-the-minute results for HEDIS measures and reporting with in-line rate calculations and live reports. Benefit from the full suite of NCQA HEDIS measures, which are updated annually.
  • Manage provider group, physician, and plan performance. Used with Risk Manager, Compliance Reporter provides graphical reports of overall measure performance, quality results trending, and plan/product line performance.
  • Calculate financial rewards for quality and pay-for-performance metrics. When paired with Risk Manager, Compliance Reporter supports full quality management
    Lifecycle, providing robust reporting and measurement.

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