FOR CALIFORNIA HEALTH PLAN COMPLIANCE TEAMS

Every APL, memo, and final rule. Read, broken down, and routed to the right team.

Clearpol Insights Pro monitors CMS, DHCS, DMHC, and HPMS, turns each new regulation into a requirement-by-requirement action plan, and lets your team ask questions in plain English. Stop tracking dozens of agency pages by hand and stop pasting hundred-page final rules into general chatbots that quietly miss things.

HIPAA compliant SOC 2 Type II & SOC 3 BAA available
Health plan compliance team reviewing regulatory requirements with Clearpol

Trusted with regulated health plan data

HIPAA Compliant AICPA SOC 2 and SOC 3
4 sources
CMS, DHCS, DMHC, and HPMS monitored in one place
30,000+
Regulatory documents tracked and searchable
~1M words
Final rules analyzed in full, well past general chatbot limits
Requirement
Every regulation broken down to the action level, by business unit
THE COMPLIANCE BOTTLENECK

The rules never stop coming, and reading them is still a manual job.

A California health plan answers to CMS, DHCS, and DMHC at once. All Plan Letters, HPMS memos, and final rules arrive on their own schedules, and each one has to be read, interpreted, and turned into work for the right departments. The volume is the problem, and so is the length.

Manual tracking across agencies

Teams spend hours each week checking agency pages for new APLs and memos, and a missed update can mean a missed deliverable or a finding.

Final rules are too long to trust to a chatbot

A single final rule can run hundreds of pages. Paste it into a general AI tool and it silently drops sections, so you never know what it missed.

Mapping requirements to owners takes days

Turning a rule into who-does-what across business units is slow, and the analysis lives in a spreadsheet that nobody can search later.

HOW IT WORKS

From a new regulation to assigned work, in four steps.

The same workflow runs whether the source is a one-page APL or a several-hundred-page CMS final rule.

1

Continuous monitoring

Clearpol watches CMS, DHCS, DMHC, and HPMS and pulls in every new APL, memo, and rule as it publishes, into one inventory.

2

Smart filtering

Guidance that does not apply to your state or lines of business is filtered out, so the team only sees what affects the plan.

3

Requirement-level analysis

Each document is broken into individual requirements, with impact, owning business unit, and the action each one calls for.

4

Routed delivery and alerts

Requirements reach the right teams with summaries and change tracking, and anyone can ask the chat about them later.

REGULATORY LIBRARY

One searchable inventory for every source that governs your plan.

DHCS All Plan Letters, DMHC All Plan Letters, HPMS memos, CMS final rules, the CFR, and provider manuals all live in a single library. Full-text search spans every document, so the answer to "what does our guidance say about this" is one query away instead of a scavenger hunt across agency websites.

  • Organized by source: DHCS APLs, DMHC APLs, HPMS memos, final rules, CFR, and provider manuals
  • Full-text search across the entire inventory, with revision dates tracked per document
  • Every entry links straight to its requirement breakdown and its source text
Regulatory Library
Search all regulatory documents...
All sources DHCS APLs DMHC APLs HPMS Memos Final Rules
DocumentSourceRequirements
APL 25-012 Continuity of CareDHCS APL18
CMS-0057-F Prior Auth & InteroperabilityFinal Rule73
HPMS Memo Network AdequacyHPMS Memo9
APL 25-009 Grievance & AppealsDHCS APL24
DMHC APL Behavioral Health AccessDMHC APL15
DRA · APL 25-012 Continuity of Care

Req 4.2: Honor existing provider relationships for up to 12 months for new members in active treatment.

Deliverable

Plan must process continuity-of-care requests within required timeframes and document determinations for each member.

Business Unit
Utilization Mgmt
SMEs
UM Director, Care Mgmt

Req 7.1: Update member-facing materials to describe continuity-of-care rights.

Implementation

Revise the Member Handbook and notices; submit updated language for regulatory review before distribution.

Business Unit
Member Services
SMEs
Comms, Compliance

Req 9.4: Maintain reporting on continuity-of-care request volumes and outcomes.

Informational

No new deliverable; confirm existing reporting captures the required fields for audit readiness.

Business Unit
Compliance
SMEs
Regulatory Affairs
DRA · DETAILED REGULATORY ANALYSIS

Every regulation, broken down to the requirement and mapped to an owner.

The DRA is where a dense document becomes a work plan. Clearpol splits each regulation into its individual requirements and, for each one, lays out the regulatory summary, the impact, the impacted stakeholders, the owning business unit and its SMEs, the roles and responsibilities, and whether the requirement is a deliverable, an implementation task, or informational.

What used to take days in a spreadsheet is produced for you, with every line traceable back to its source text and exportable for your committees.

COMPLIANCE CHAT

Ask in plain English. Get answers with the citation attached.

Anyone on the team can ask a question and get an answer drawn from your own inventory, with the source document and section cited so it can be verified. The chat is grounded in the library, so when an APL or memo updates, the answers do too. No more digging through PDFs to settle a question during implementation.

  • Answers cite the exact document and section they came from
  • Grounded in your inventory, not the open internet, so it stays on-policy
  • Share conversations across the team and keep a history of what was asked
Compliance Assistant
What are our timeframes for processing a continuity-of-care request under the latest DHCS guidance?

Under APL 25-012, the plan must complete a continuity-of-care determination within the required timeframe after a complete request, and allow eligible members to continue with an out-of-network provider for up to 12 months while in active treatment.

Determinations and member notifications must be documented for each request.

APL 25-012 · §4.2 APL 25-012 · §7.1
Ask about any policy, APL, memo, or final rule...
DASHBOARD, SEARCH & ALERTS

See what changed, find anything, and make sure the right people know.

A live dashboard shows incoming guidance by source and by the kind of action it requires. Search reaches every document, and alert subscriptions push the right updates to the right departments.

By source

  • DHCS All Plan Letters42
  • DMHC All Plan Letters17
  • HPMS Memos28
  • CMS Final Rules6

By action required

  • Deliverable31
  • Implementation46
  • Informational88
  • Not Applicable12

Recent alerts

  • New DHCS APL routed to Utilization Mgmt
  • Revision to network adequacy memo, change summary ready
  • 3 new requirements assigned to Member Services
BUILT FOR THE RULES NOBODY ELSE CAN READ

Hundred-page final rules, analyzed in full.

General chatbots have a hard limit on how much text they can hold, so a long CMS final rule gets truncated and sections silently disappear. Clearpol takes a different approach: it splits the document into pieces, analyzes each one, then reconciles the results back into a single requirement set. Rules around the size of CMS-0057-F on prior authorization and interoperability are handled end to end, not skimmed.

You still apply your own judgment and your plan-specific lens. Clearpol just makes sure the starting point is complete.

~1M
words per document

Roughly a thousand-plus pages analyzed without dropping content, far beyond what a single chatbot prompt can hold.

PURPOSE-BUILT FOR PAYERS

Designed around how health plan compliance teams actually work.

Requirement breakdown

Every regulation split into specific requirements with business-unit-level impact.

Change intelligence

Side-by-side revision comparisons and summaries show exactly what is new.

Custom alerts and workflows

The right teams are notified about the guidance that affects their departments.

Searchable knowledge base

Find any regulation or requirement instantly with search and grounded chat.

Cybersecurity protection illustration with shield and digital network

Security and compliance you can trust

  • HIPAA compliant

    Our systems are fully compliant with HIPAA, so any protected information stays secure.

  • SOC 2 Type II and SOC 3

    We maintain SOC 2 Type II and SOC 3 controls for security, availability, and confidentiality.

Trust Center

Book a demo or send us a note

See your own APLs and final rules broken down.

Bring a recent regulation and we will walk your team through the library, the requirement breakdown, and the chat in a 30-minute demo.

Book a demo