Every capability you need to run a modern healthcare compliance program — from data integration through audit readiness, investigation, and corrective action.
We meet compliance programs where they already work — any data source, any existing workflow, with governance built in from day one.
Unified schema across CCLF, EDI 837 P/I, flat files, and direct API feeds. We normalize everything into a single compliance layer — no ETL, no translation layer for your team.
Role-based access, SSO, case routing, and a full audit trail of every action. Pamastay slots into the tools your team already uses without asking them to re-learn anything.
SFTP with GPG encryption, BAA on file, data-residency controls. HIPAA-compliant ingestion whether you're a health plan, ACO, medical group, or private practice.
Healthcare-specific detection logic running on every claim, tuned to what regulators actually audit — not generic anomaly algorithms.
MUE edits, orphan DME, skin substitute patterns, duplicate billing, cost outliers, and your own configurable rules — all scored per claim, provider, and cohort.
HCC gap detection, projected RAF scores, and RADV sampling exposure — before CMS finalizes payment. See which HCCs are most likely to be audited and which may have the most documentation risk.
Specialty-adjusted peer comparisons, coding-pattern analysis, and referral-pattern signals. Identify the 10% of providers driving 40% of variance — so coaching lands where it matters.
Always-on surveillance across your claims feed with configurable thresholds, real-time alerts, and routing to the right reviewer. Quarterly cycles become an operating rhythm.
Built for the moment an auditor asks "how do you monitor for this?" — and your team needs evidence, not an answer.
Tag claims, HCCs, providers, and cases as audit-relevant. Every tag carries priority, scope, evidence links, and status — so nothing gets lost between discovery and response.
Auto-generated narratives per audit scope: which HCCs were flagged, what evidence supports each finding, what the outcome was. What used to take days of manual assembly is one click.
RADV-readiness scoring per HCC, provider, and sample cohort. Triage the audit exposure that actually matters before the CMS letter arrives — and prove your readiness to the board.
One-click export of detection logic, findings history, remediation tracking, and full evidence lineage. Ready to hand to an OIG auditor, CMS reviewer, or your own compliance committee.
OIG's Element 7 in practice — investigation, remediation, and verification, tracked end to end.
Assign, route, and track every finding from discovery through resolution. Evidence, notes, and decisions live with the case — not in anyone's inbox.
From finding to policy change to provider education to outcome — every intervention captured with dates, owners, and status. Prove to regulators that findings drove action.
Before/after data comparison plus verification proof, documented for your next audit. Closing the loop isn't a claim — it's a record.
Built for healthcare data from day one.
Full HIPAA compliance with BAA execution
Certified security controls and processes
End-to-end encryption for data at rest and in transit
Secure cloud infrastructure with 99.9% uptime
Book a demo to see how these features work with your data.