See How Every Delegate Actually Performs
Your UM vendor says they're performing. Your QBR says everything is on track. But do you have case-level data showing who handles what, how fast, and at what cost - across every vendor, every team, every workflow?
Built for health plans and the clinical operations teams running them.The Problem
CMS's #1 audit finding is delegation oversight failure
CMS explicitly flagged FDR oversight failures as the top audit finding in their 2024 Program Audit Report. Plans are 100% liable for everything their delegates do - UM decisions, credentialing, claims processing. CMS expects pre-delegation audits, continuous SLA monitoring, structured audits, and documented CAP closure. Most plans track all of this in Excel and email.
Vendor QBRs are self-reported
Your only view of vendor performance comes from the vendor's own QBR slides. No independent, case-level data. When CMS shows up and asks 'show me your continuous monitoring evidence for Delegate X's PA turnaround times,' the answer is often a blank stare. Self-reported QBRs don't meet CMS's documentation standard.
56% of cases may have no assigned owner
Ownership gaps cause SLA breaches and invisible cost. When nobody owns a case at a given stage, it sits until someone notices - if they notice at all.
Why This Can't Wait
CMS 2024 Program Audit Report: FDR oversight is the #1 finding
CMS's own audit report identifies delegation oversight failures as the top compliance finding. MAOs remain 100% liable for delegate performance. CMS expects continuous monitoring evidence, not annual reviews. Plans doing annual spot-checks are operating on borrowed time.
CMS audit expansion: Program Audit notices rolling out
Expanded remote fieldwork with universe file submissions due 15 business days from notice. Q4 2025-2026 includes Data Validation audits and Corrective Action Plan reviews.
Documentation must "stand on its own without interpretation"
CMS signaled tougher scrutiny - expecting documentation integrity that self-reported vendor QBRs don't meet.
Most plans run delegation oversight on spreadsheets and email
Pre-delegation audits tracked in shared drives. SLA monitoring via monthly vendor reports. CAP follow-up in email threads. When CMS asks for continuous monitoring evidence, plans scramble to assemble it from 5 different systems. The gap between what CMS expects and how plans actually operate is a compliance liability.
Hold Every Delegate to the Same Standard
Operon ingests case-level data from your workflow systems and tags every resource by team, vendor, and type. You get an independent view of who handles what, how fast, and at what cost - from your data, not your vendor's QBR slides.
Resource Leaderboard
Your QBR always looks good because the data comes from the vendor. The Leaderboard ranks every resource - internal, external, human, AI - by actual throughput, handle time, and pickup speed. Side-by-side comparison, from your own systems.
Current Assignments Matrix
56% of cases may have no assigned owner at a given stage. This view shows which resources own which cases right now, and highlights the unassigned lane - cases burning SLA budget with nobody accountable.
Workload Heatmap
Is work distributed fairly across your vendors? The Heatmap shows daily case volume by resource, color-coded by intensity. Spot overloaded resources, underutilized capacity, and the staffing gaps that cause silent SLA erosion.
Loop Atlas
Vendors are measured on throughput. But what about rework? Loop Atlas shows which resources generate the most repeat touches - cases that bounce back through the same stages because they weren't handled right the first time. The cost of rework is invisible until you trace it.
How It Works
Connect
Read-only integrations with your workflow systems. Every resource is tagged by team, vendor, and type - human, AI, or automated.
See
Live vendor performance dashboards in 2-4 weeks. Independent scorecards based on your data, not theirs.
Act
Walk into your next QBR with independent data. Make insource vs. outsource decisions based on evidence, not vendor self-reports.
See It on Your Own Cases
30 minutes with our team. We'll look at the workflow you run today and show what Operon would surface in the first weeks.