The Sevana Platform
Medicare Advantage Compliance Software Built for the 2026 Audit Framework
The 2026 CMS Program Audit reset retired scoring and the ICAR/ORCA classifications and replaced them with CAR, Observation, and IDS findings. The spreadsheets and single-purpose tools that fit the old playbook do not fit the new one.
Sevana Health is a compliance platform built exclusively for Medicare Advantage and Part D plans: eight integrated modules that validate your universes, track your guidance, and record your oversight so the evidence of a working compliance program accumulates as you operate.
Why Purpose-Built for Medicare Advantage Matters
Most compliance software in healthcare is general-purpose: configurable workflows, document storage, and task tracking that could serve a hospital, a device manufacturer, or a health plan equally well. The Medicare-specific logic is left for the customer to build.
A CMS program audit does not test generic workflows. It tests whether your plan can produce accurate universe files in CMS-defined record layouts within 15 business days of the engagement letter, whether dates are in CCYY/MM/DD format, whether cross-table relationships hold, and whether your oversight activities are documented well enough to carry a CPE discussion. Those requirements are specific, published, and testable, and software either encodes them or it does not.
Sevana encodes them. CMS publishes the field-level record layouts for each universe through OMB-approved form CMS-10717; Sevana translates those specifications into 1,600+ discrete validation rules covering all five audit protocols. When the layouts change, the rules change, and every client is validating against the current specification.
Eight Modules, One Data Spine
Each module exists because a specific process breaks at MA plans. They share data rather than running as silos: a memo in Guidance Distribution can become a policy task, a work plan activity, and a line in your oversight reporting without re-entry. See the full module catalog for screenshots and detail pages.
CMS Universe Scrubber
FlagshipThe problem: Universe files with format, timeliness, or cross-table errors become IDS findings.
What it does: Validates ODAG, CDAG, FA, SNPCC, and CPE files against the CMS record layouts before anything reaches CMS.
AI Policy Intelligence
NewestThe problem: Matching each HPMS memo against the entire P&P library by hand takes days and leaves no trail.
What it does: Cross-references new memos against your policies and surfaces likely-affected documents for your team to review, ranked by impact.
The problem: Memos get forwarded by email and the acknowledgment trail dies in the inbox.
What it does: Routes guidance to owners, tracks acknowledgment and action, and keeps the closed-loop record auditors ask for.
The problem: Version history and review cycles live in folders that cannot prove what was in force on a given date.
What it does: Maintains the controlled P&P library with review schedules, approvals, and point-in-time history.
The problem: The annual risk assessment gets built in a spreadsheet and never drives the work plan.
What it does: Scores risk across operational areas and feeds the result directly into work planning.
The problem: Auditing and monitoring activities are tracked in places that cannot produce a defensible COA universe.
What it does: Plans and records oversight activities so the evidence of a working compliance program accumulates as you operate.
The problem: FWA investigations handled ad hoc cannot show intake, chain of review, or resolution.
What it does: Structures incidents and investigations from intake through corrective action with a complete case record.
The problem: Governance asks how the program is performing and the answer takes a week to assemble.
What it does: Reports oversight results to committees and the board from the data the other modules already hold.
Designed Around the 2026 Audit Framework
Under the 2026 framework, findings fall into three classes: Corrective Action Required (CAR), Observation, and Invalid Data Submission (IDS). IDS is the one a plan can fully prevent before the audit begins, because it is cited when a sponsor cannot produce an accurate and complete universe within three submission attempts. Catching format, timeliness, and cross-table errors before submission is exactly the mechanical work software should own. Our guide to Invalid Data Submission in 2026 covers what triggers IDS and how plans prevent it.
CPE evaluation now runs as a discussion-based review during fieldwork, a pilot we refer to as "Collaborating on Compliance" (our shorthand, not an official CMS program name). The COA universe is the agenda for that conversation. Plans that record auditing, monitoring, and investigation activity as they go walk in with their evidence already assembled; plans that reconstruct it after the engagement letter spend their 15 business days on archaeology.
For the full picture of protocols, deadlines, and the audit lifecycle, start with our complete CMS Program Audit guide.
Proof, Not Promises
1,600+
Validation rules translated from the CMS-10717 record layouts
5
Audit protocols covered: ODAG, CDAG, FA, SNPCC, CPE
70,000+
Rows validated in minutes, not review cycles
100%
Client retention since our first engagement
We completed our SOC 2® Type 2 examination in February 2026: an independent service auditor evaluated our security controls and confirmed they operated effectively over time. Plans handling enrollee data in universe files should expect that from any vendor; ours is available under NDA during evaluation.
Who Runs on Sevana
- •Compliance teams at MA and Part D plans who own program audit response, universe submissions, and the compliance program elements at 42 CFR 422.503(b)(4)(vi).
- •Operations teams whose determinations, appeals, grievances, and effectuations become the universe rows CMS samples.
- •Special Needs Plan operators, including I-SNPs, who face the SNPCC protocol on top of the standard universes. See our I-SNP compliance page.
- •Delegated-entity oversight functions validating universe data produced by TPAs and PBMs before it carries the plan's name to CMS.
Frequently Asked Questions
What is Medicare Advantage compliance software?
Software that operationalizes the compliance program CMS requires of MA and Part D sponsors at 42 CFR 422.503(b)(4)(vi) and 423.504(b)(4)(vi): universe file validation for program audits, HPMS memo tracking and policy traceability, risk assessment, auditing and monitoring work plans, incident and FWA investigation management, and oversight reporting. It differs from general healthcare compliance tools by being built around CMS-specific artifacts such as universe record layouts and audit protocols.
How is it different from general healthcare GRC software?
General governance, risk, and compliance platforms model generic workflows and leave the Medicare-specific logic to the customer. MA-specific software ships with the CMS artifacts already encoded: the universe table layouts for ODAG, CDAG, FA, SNPCC, and CPE, the timeliness standards CMS tests, CCYY/MM/DD format rules, and the 2026 CAR, Observation, and IDS finding framework. That difference shows up during an audit, when the deliverables are CMS-defined files on CMS deadlines rather than generic reports.
What should a health plan look for when evaluating compliance software?
Ask whether the vendor can name the current audit protocols and universe tables without prompting, whether validation rules trace to the CMS record layout specifications, whether the modules share data or run as silos, how oversight activity gets captured for the COA universe, and whether the vendor has completed an independent security examination such as SOC 2 Type 2. Ask to see the tool run against a real universe file during the demo.
Does compliance software replace a compliance team’s judgment?
No. Software is good at the mechanical layer: format validation, cross-table consistency, deadline tracking, routing, and record keeping. Judgment calls, root cause analysis, corrective action decisions, and the audit conversation itself stay with the compliance team. Sevana’s AI features follow the same principle: they surface likely-affected policies for your team to review rather than changing anything on their own.
See the Platform Against Your Own Files
The fastest way to evaluate compliance software is to watch it run on a real universe. Bring one to the demo, or start with the free Universe Header Check to test your file structure right now.