AI that reads every CMS memo, routes every audit finding, validates every universe submission, and builds the evidence trail regulators expect. In minutes, not weeks.
In May 2025, CMS announced it will audit every Medicare Advantage contract annually — up from roughly 60 per year. The era of "hope we don't get picked" is over.
Your team manually reads every CMS guidance memo, extracts action items, assigns to departments, and tracks completion in spreadsheets. One missed deadline can trigger enforcement action.
When CMS requests universe data, your team scrambles to validate files, check timeliness against 42 CFR deadlines, and compile evidence. Scrubbing a single ODAG submission manually can take days.
You don't know which HCCs are unsupported until CMS tells you. By then, extrapolation math can turn a 5% error rate into a $50M+ clawback. OIG identified $7.5B in HRA-only diagnosis payments alone.
From the moment a CMS memo arrives to the day an auditor requests evidence — every step automated, every decision tracked, every deadline enforced.
Every document classified, analyzed, and routed in under 30 seconds. Memos, audit reports, universe files, vendor attestations — each with confidence scoring and multi-agent consensus.
CMS memos parsed into sponsor-facing action items, auto-assigned to departments with dual due-date tracking: external CMS deadline and your internal safety buffer. SLA escalation when items slip.
18 CMS protocol schemas validated automatically — ODAG, CDAG, FA, SNPCC, CPE. Header fingerprinting identifies file type, timeliness checking runs against 42 CFR deadlines, errors exported color-coded.
Upload a 50-page audit PDF — AI extracts deficiencies, groups into CAPs, guides 5-Whys root cause analysis with AI validation, and enforces phase-locked milestone workflows through to closure.
Bidirectional AI finds missing HCC revenue and flags audit-exposed diagnoses simultaneously. Neuro-symbolic engine: rules for certainty, GPT-4o for ambiguity. Real-time RADV exposure modeling.
Ask any Medicare Advantage regulatory question in natural language. Get source-cited answers from 26+ CMS documents — with inline CFR references, document attribution, and confidence scores.
POM is the intelligence layer. Every inbound document — CMS memos, audit reports, vendor files, universe submissions — enters POM, gets classified with confidence scoring, and routes to the right module automatically. The Oracle dashboard gives leadership a single priority-ranked view of every compliance action across the entire organization.
PMRA is the only platform that handles both sides of risk adjustment simultaneously: identifying undercoded HCCs your plan is losing revenue on, and flagging audit-exposed diagnoses before CMS finds them. The neuro-symbolic engine uses deterministic rules for high-confidence signals (Entresto present but no HF code = definite gap) and GPT-4o for complex clinical patterns — reducing API costs 40-60% while maintaining accuracy.
Four steps. Fully automated. Every decision logged.
CMS memos, audit reports, vendor files, and universe submissions enter via upload, email monitoring, or API.
POM reads every document, determines type and urgency, and routes to the right module with confidence scoring.
Department leads see obligations, enter deliverable plans, upload evidence, mark milestones complete. AI validates responses.
Every classification, routing decision, action item, and approval is logged immutably. The evidence is already organized.
Purpose-built for the regulatory complexity that Medicare Advantage compliance actually requires.
Consultants charge $200K for a mock RADV audit that takes 8 weeks. PCG runs one in minutes for zero marginal cost. Consultants leave; the platform stays and gets smarter with every interaction.
Your compliance program cannot run on email and Excel when CMS is auditing every contract annually. You need infrastructure that tracks 18 CMS protocols, enforces deadlines, and produces audit evidence automatically.
ChatGPT doesn't know ODAG from CDAG. PCG's AI is trained on CMS protocols, learns from your team's corrections, enforces timeliness rules from 42 CFR Part 422/423, and runs on HIPAA-compliant Azure infrastructure.
Every architectural decision optimized for regulated healthcare environments. No shortcuts.
All AI runs on Azure OpenAI within your environment. No data sent to third-party APIs. No data used for model training.
PHI de-identified before any LLM processing. End-to-end encryption. Business Associate Agreement coverage.
30-minute session inactivity timeout. Immutable audit logs on every action. Rate limiting on all authentication endpoints.
Multi-tenant by design. Every query scoped by organization. Your data is invisible to other organizations on the platform.
Every classification, routing decision, approval, and evidence submission logged immutably for the full CMS audit cycle.
Member identifiers stripped before any LLM processing. Risk adjustment AI uses de-identified clinical data only. Full compliance with 45 CFR Part 164.
Schedule a 30-minute walkthrough. We'll show you exactly how PCG handles your CMS memos, audit findings, and universe submissions — with your data, in your regulatory context.