The Transformation

Before and After PCG

Before PCG

CMS memos land in a shared inbox. Someone reads and summarizes in a spreadsheet.
Action items assigned via email. No tracking on who received what.
Universe files manually reviewed column-by-column. Timeliness calculated by hand.
Audit prep takes 6-8 weeks. Evidence scattered across drives and inboxes.
Risk adjustment exposure unknown until CMS audit results arrive.

After PCG

CMS memos analyzed by AI in seconds. Obligations extracted and routed automatically.
Action items assigned to departments with dual deadlines and SLA escalation.
Universe files validated against 18 CMS protocols. Errors categorized and color-coded.
Audit evidence builds itself. Every decision logged immutably for 7 years.
Risk adjustment exposure modeled in real time. Mock RADV in minutes, not months.
The Workflow

Four Steps to Continuous Compliance

Each step is automated, auditable, and designed to keep your organization ahead of regulatory deadlines rather than reacting to them.

1

Documents Enter the System

CMS regulatory memos, audit reports, vendor attestations, universe submission files, and provider network data enter PCG via direct upload, monitored email inboxes, or API integration. Each document is stored with a SHA-256 hash for duplicate detection — if your team accidentally uploads the same memo twice, the system catches it and returns the existing analysis.

2

AI Classifies, Analyzes, and Routes

The Precision Overmind (POM) reads every document using GPT-4o at temperature 0.1 for maximum determinism. It classifies the document type (memo, audit report, universe file, vendor document, final rule), extracts key findings and CFR citations, calculates urgency based on regulatory deadlines, and routes to the appropriate module. When classification is ambiguous, downstream agent consensus resolves the conflict. Every routing decision is logged with confidence scores.

3

Teams Act on Structured Assignments

Department leads see their assigned obligations in role-specific dashboards. For CMS memos: action items with accountable departments, internal deadlines, and external CMS due dates. For audit findings: AI-grouped CAPs with 5-Whys RCA workflows. For universe files: validation results with timeliness checks and categorized errors. Teams enter deliverable plans, upload evidence, and mark milestones complete. AI evaluates sponsor readiness and flags gaps before submission.

4

The Audit Trail Builds Itself

Every classification, routing decision, action item assignment, department response, approval, escalation, and completion is logged immutably. When auditors request evidence, it's already organized by regulation, date, department, and decision type. The compliance calendar aggregates deadlines from every module — Memo, CAP, Scrubber, CMS, Medicaid — into a single view with four normalized states: upcoming, due soon, overdue, satisfied.

Under the Hood

What the AI Actually Does

Concrete examples of what PCG processes every day for a Medicare Advantage compliance team.

A CMS Memo Arrives

Regulatory Intelligence Module

A 47-page CMS guidance memo on CY2026 benefit standards enters the system. POM classifies it as a "memo" with 0.96 confidence. The memo is chunked into 3,500-character segments, each analyzed independently by GPT-4o. The system extracts 4 sponsor-facing action items (filtering out CMS internal tasks), maps them to Pharmacy, Enrollment, and Finance departments, and calculates internal due dates with a 7-day buffer before the external CMS deadline.

Universe Files Need Validation

Audit Scrubber Module

Your team uploads an ODAG Table 1 file with 5,000 enrollee records. The Scrubber's header fingerprinting engine identifies the file type with 92% confidence by scoring column headers against all 18 protocol specifications. It validates every row: checking enrollee IDs are exactly 11 uppercase alphanumeric characters, determination dates are in CCYY/MM/DD format, and timeliness falls within the 14-day (or 28-day with extension) reconsideration standard.

An Audit Finding Needs a CAP

CAP Management Module

CMS sends a 50-page compliance examination report. The CAP Tool extracts deficiency statements from each page, groups related findings into 3-6 cohesive Corrective Action Plans, and enriches each with the operational failure, enrollee impact, and applicable CFR citations. Your team then works through 5-Whys root cause analysis — the AI validates each "Why" for logical soundness, rejecting circular reasoning or surface-level causation.

Risk Adjustment Review

PMRA Module

For a member with prior-year Heart Failure (HCC 80) but no current-year HF code, the rules engine detects Entresto (sacubitril/valsartan) prescription fills — a drug with no other FDA indication. The system flags this as a 90% confidence recapture opportunity worth approximately $4,416/year. Simultaneously, it flags another member's HCC 80 sourced only from a vendor HRA with no confirming office visit — a high-risk deletion target per OIG guidance.

Ready to See It With Your Data?

Bring your CMS memos, your universe files, your audit findings. We'll run them through the platform live and show you what automated compliance looks like.