We built PCG because Medicare Advantage compliance is too important — and too complex — to run on spreadsheets.
Medicare Advantage serves over 33.8 million beneficiaries. The organizations that manage these plans operate under one of the most complex regulatory frameworks in healthcare — 42 CFR Parts 422, 423, and 438 — with annual CMS audits, OIG investigations, and enforcement actions that can reach nine figures.
Yet the compliance teams responsible for navigating this complexity still rely on email chains, shared drives, and Excel workbooks. They manually read CMS memos, assign action items through Slack, track deadlines in calendars, validate universe files by eye, and compile audit evidence in a scramble when CMS comes calling.
When CMS announced in May 2025 that it would audit every MA contract annually — not the 60-odd contracts it had previously selected — the gap between regulatory demand and operational capacity became impossible to ignore.
PCG is not a bolt-on AI feature added to a generic workflow tool. It's a compliance operating system built from the ground up for Medicare Advantage — with the regulatory logic of 42 CFR encoded into every module, every validation rule, and every AI prompt.
Our Precision Overmind (POM) classifies every inbound regulatory document in seconds, using GPT-4o trained on CMS-specific system prompts, with multi-agent consensus when classification is ambiguous. But we don't trust AI alone — every output is a draft for human review, every decision is logged immutably, and every routing correction teaches the system to be better.
Our Audit Scrubber validates against all 18 CMS universe protocol schemas — not with generic data quality rules, but with the actual timeliness thresholds from 42 CFR Part 422 and 423. Our PMRA platform handles both sides of risk adjustment — finding undercoded conditions your plan is losing revenue on, and flagging audit-exposed diagnoses before CMS finds them — with a neuro-symbolic engine that uses rules for certainty and AI for ambiguity.
We start with the regulatory requirement — the specific CFR section, the specific CMS protocol, the specific timeliness threshold — and build the automation around it. The AI serves the domain, not the other way around.
Every AI output is a draft for human review. POM never auto-executes compliance actions. Phase-locked workflows prevent skipping steps. The platform amplifies human judgment — it doesn't replace it.
Every routing correction, every coder decision, every reroute approval becomes training data. After six months, PCG isn't generic software — it's tuned to your organization's terminology, your team's judgment, and your regulatory priorities.
Azure OpenAI for all AI processing. PHI de-identified before any LLM call. SOC 2 aligned controls. Organization-level data isolation. 30-minute session timeouts. 7-year immutable audit trails. These aren't add-ons — they're architectural decisions made on day one.
The numbers behind the regulatory environment PCG is built for.
MA beneficiaries enrolled
Annual MA capitation payments
Contracts now audited annually
Parts 422, 423, 438 — the regulatory framework
Whether you're preparing for your first RADV audit or scaling compliance across multiple contracts, we'd like to understand your challenges.