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Atlanta, GA. – December 2, 2008 – Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk and compliance (eGRC) and the most widely used solution in the healthcare industry, today announced the general availability of its claims audit solution that helps organizations manage a wide variety of claims audits and appeals, including those conducted under the CMS Medicare Recovery Audit Contractor (RAC) program.

The Compliance 360 Claims Auditor is designed specifically for industries such as healthcare, insurance, financial services and student lending where the government is taking an increasingly active role in regulatory scrutiny and enforcement. Regulated organizations in these industries are being asked with increasing frequency to open their records and demonstrate that they are in compliance with the regulatory agency’s rules and reimbursement policies. The Compliance 360 Claims Auditor allows organizations to maintain one central system of record for all types of claims audits and provides management with a system of alerts, dashboards, and workflow.

“We’ve worked closely with industry experts and our customers that were included in the RAC pilot program, to design and deliver a solution that will help organizations protect their legitimate revenues from claims audits and specifically, the onslaught of CMS Medicare recovery audit contractors,” said Steve McGraw, president and CEO of Compliance 360. “The Compliance 360 Claims Auditor provides comprehensive support for the entire audit process, from proactive self-defense audits and analysis of high risk areas, to audit response and management of complex, multi-step appeals processes, with executive dashboards to monitor the status of pending appeals and gauge potential financial liabilities. As an added bonus for our customers, the Compliance 360 Claims Auditor has been designed for managing a wide variety of claims audits in addition to RAC. As we’ve been doing since we first introduced the Compliance 360 suite 8 years ago, with the enhanced Claims Auditor, we’re providing a comprehensive solution to address a broad set of compliance requirements across the entire organization.”

When used to manage RAC audits, the Compliance 360 Claims Auditor helps healthcare providers:

• Establish their “Claims Audit System of Record” by using the Compliance 360 Claims Auditor as a central location for managing all claims audits and storing all related information.
• Manage the entire audit process across all departments and create organizational accountability. With highly configurable workflow and specific workflow templates for different types of claims audits, non-technical personnel can efficiently automate processes, activities, and due-date alerts across all departments in their organizations.
• Provide executive visibility with real-time dashboards. Executives and other key decision makers can closely monitor the status of pending appeals and the financial exposure of active audits. The Claims Auditor also enables proactive risk analysis by identifying trends related to high risk areas such as targeted DRG’s, common claims coding errors and denial reasons, as well as specific facilities and staff.
• Proactively establish barriers to claims auditors by demonstrating an “in control” status with efficient self assessments and internal defense audits. The results of these proactive assessments are compiled in the Compliance 360 Virtual Evidence Room™ to enable rapid, complete response to audit requests.
• Using the comprehensive Compliance 360 GRC platform, organizations can incorporate claims audit management into their broader compliance and risk management programs. This is important as they seek to address the increasing governance and risk management needs of their boards of directors in today’s climate of increasing demands for regulatory oversight and scrutiny of bonds rating agencies.

“The feedback from our customers has been very positive,” said Debbie Luyk, director of product management for Compliance 360. “We have seen a great deal of flux in the specific requirements for the claims audit process. The flexibility of our configurable workflow and alerts will help insulate our customers from manual rework if the appeals process continues to change. We will continue to work with our customers to enhance the solution and ensure that their future requirements are addressed as the RAC program unfolds.”

The Compliance 360 Claims Auditor has been designed for managing a wide variety of claims audits including the Medicare Recovery Audit Contractor (RAC) program, Medicare Program Safeguard Contractor (PSC) audits, Medicare Comprehensive Error Rate Testing (CERT) audits, Medicaid Integrity Contractor (MIC) audits, Medicaid Fraud Control Unit (MFCU) audits and other forms of claims audits. The Compliance 360 Claims Auditor is available immediately and limited online demonstrations are now available. To submit a request to participate in an online demonstration, please visit www.compliance360.com/RAC.

About Compliance 360 for Healthcare

The Compliance 360 Software-as-a-Service (SaaS) solution for healthcare enables a comprehensive approach to regulatory compliance and risk management through a comprehensive enterprise-wide platform. With this solution, healthcare providers have the unique ability to link all their compliance activities and documentation to the pertinent regulations through a Virtual Evidence Room™. The Compliance 360 solution for healthcare addresses the need for policy management, centralized regulatory management (including HIPAA, Medicare, EMTALA, STARK, False Claims Act (FCA) and other regulations), Joint Commission Accreditation, OIG corporate integrity agreements (CIA), adverse-event management, contract management, surveys, remediation projects, claims audit management for Medicare CMS RAC audits, self assessments, and enterprise risk management (ERM). Industry leading healthcare providers that depend on Compliance 360 include Billings Clinic, Catholic Healthcare Systems, IASIS Healthcare, InterDent, Jackson Memorial Hospital, LifeLink Foundation, MultiCare Health System, Nassau University Medical Center, PeaceHealth, Saint Joseph's Hospital of Atlanta, St. Elizabeth Medical Center, St. Luke's Regional Medical Center and Spectrum Health. To learn more about the Compliance 360 solution for healthcare, visit www.compliance360.com/healthcare.

About Compliance 360

Compliance 360 is a leading provider of enterprise governance, risk management and compliance solutions for companies that operate in highly regulated industries. The Compliance 360 Software-as-a-Service (SaaS) solution suite helps companies address policies and procedures management, regulatory compliance management, internal and external audits, incident management, fraud, waste & abuse, surveys, contract management, accreditation, risk management and IT governance. Customers benefit by reducing risks, improving efficiencies and protecting their brands. Compliance 360 is headquartered in Atlanta, GA and assists over 100,000 active users in highly regulated complex business environments including healthcare, insurance, financial services and others. For more information, visit www.compliance360.com.