Sagility and Inovaare Partner to Deliver Audit-Ready Appeals and Grievances Operations for Medicare Advantage and Medicaid Health Plans

• The partnership combines Inovaare's AI-native HealthCloud platform for regulated payer workflows — including appeals and grievances, compliance reporting, and member and provider services — with Sagility's technology-led business operations model to provide health plans with a more integrated approach to technology and operational transformation. • The combined model is designed to accelerate implementation and time to value while reducing the complexity and total cost associated with independently implementing and managing technology and operations. • Integrated technology and operations can help create greater accountability for quality, service-level performance, and evolving CMS and state regulatory requirements, including continuous audit readiness. • The partnership is designed to extend value beyond operational efficiencies to support broader business and financial outcomes for health plans.

Sagility, a leading technology business operations solutions and services provider in the healthcare sector, and Inovaare, the AI-native compliance operations platform company offering purpose-built solutions for U.S. healthcare payers, today announced a strategic partnership that brings healthcare compliance and operations together in one delivery model for health plans. The initial joint offering gives Medicare Advantage and Medicaid health plans an integrated approach to appeals and grievances, with both companies accountable for meeting CMS decision timeframes and producing audit-ready universes.

The partnership combines Inovaare's AI-native HealthCloud platform — which builds CMS requirements, decision timeframes, and audit-ready universe reporting directly into appeals and grievances, member services, and provider services workflows — with Sagility's deep healthcare domain expertise and scaled operational capabilities. Together, the companies aim to reduce the complexity health plans face when implementing technology separately from the business operations it supports, creating a more direct path from implementation to measurable operational outcomes.

Accelerating the Path from Technology to Outcomes

Health plans continue to navigate growing operational complexity, evolving regulatory requirements, and pressure to improve performance while controlling administrative costs. Technology can address many of these challenges, but implementing a platform is only one part of the transformation.

When technology implementation, ongoing support, change management, and healthcare operations are managed separately, health plans can face longer implementation cycles, fragmented accountability, and added operational complexity.

Through the Sagility and Inovaare partnership, technology and operations can be aligned around common client objectives, from implementation through ongoing delivery. The model is designed to accelerate time to value, reduce total cost of ownership, and establish clearer accountability for operational performance and regulatory compliance.

The companies' initial joint offering focuses on appeals and grievances for Medicare Advantage and Medicaid health plans, with additional payer functions, including utilization management, planned to follow.

"Health plans are moving beyond disconnected point solutions and are looking for technology that translates into measurable operational and business outcomes," said Bill Bottomley, Vice President, Strategic Alliances at Sagility. "By combining Inovaare's compliance-ready platform with Sagility's deep healthcare operations expertise, we help clients accelerate time to value, simplify implementation, and reduce the complexity of managing technology and operations across multiple environments. Together, we enable plans to strengthen quality and compliance performance through more efficient appeals and grievances management, helping support the timely resolutions that contribute to Medicare Part C and Part D Star Ratings success."

"CMS doesn't evaluate health plans on the software they buy. It evaluates whether every appeal and grievance met its timeframe and whether the universe proves it," said Pravat Rout, CEO of Inovaare. "We built our AI-powered HealthCloud with CMS requirements at its core. Sagility brings the operational scale to run it every day. Together, health plans get audit readiness that holds up any day of the year, not only the week a program audit starts, and appeals performance that supports their Star Ratings."

Four Areas of Client Value

The strategic partnership is designed to deliver value across four primary areas:

• Speed to value: Combining Inovaare's AI-powered HealthCloud platform with Sagility's operational capabilities streamlines implementation and operationalization, helping health plans reach desired outcomes faster than managing technology implementation and operations independently.
• Lower total cost of ownership: An integrated model can reduce the cost and complexity associated with separately managing technology implementation, IT support, healthcare operations, change management, and ongoing regulatory updates.
• Quality, compliance, and accountability: Aligning technology and operations creates greater end-to-end accountability for service performance and helps to ensure that evolving CMS and state regulatory requirements — from decision timeframes and notice requirements to audit-ready universe reporting — are reflected across both technology and operational workflows.
• Business and financial impact: Depending on the use case, improved healthcare operations can create value beyond administrative cost reduction, including opportunities to protect Star Ratings performance, reduce CMS audit findings and related penalty exposure, improve payment accuracy, and support stronger clinical and financial performance.

About Sagility

Sagility is an AI-led, U.S. healthcare-focused business operations solutions and services company that supports payers, providers, and their partners in delivering best-in-class operations, enhancing member and provider experiences, and improving the quality of care, all while ensuring cost-effective financial and clinical outcomes. With more than 25 years of exclusive focus in healthcare, Sagility's dedicated experts address complex healthcare challenges through deep domain expertise and technology innovations. Serving over 80 healthcare clients, including 7 of the top 10 U.S. health plans, Sagility delivers end-to-end operational transformation at scale through a model built on accountability, transparency, and measurable outcomes. The company delivers these services through its skilled talent pool of nearly 50,000 professionals across five global service delivery centers located in the US, India, the Philippines, Jamaica, and Colombia. To learn more, visit: https://sagility.com/

About Inovaare

Inovaare Corporation is an AI-native compliance operations HealthTech company with solutions purpose-built for U.S. healthcare payers. Its HealthCloud platform — spanning appeals and grievances, member and provider services, delegation and vendor oversight, risk management and compliance, and internal and external audit — helps Medicare Advantage, Medicaid, Dual Eligible Special Needs Plans, and commercial health plans automate high-volume regulated workflows, stay continuously ready for CMS program audits, and protect Star Ratings performance. Inovaare delivers HealthCloud as a software-as-a-service (SaaS) platform or as a fully managed business process as a service (BPaaS) engagement that brings platform, AI, and compliance expertise together under single accountability. Inovaare serves more than 50 million members through more than 40 payer organizations. To learn more, visit www.inovaare.com.

Media Contact

Addie Reed, Sagility, 1 312-766-5515, [email protected], www.sagilityhealth.com

SOURCE Sagility