OmniCompli™
The Unified Source of Compliance
OmniCompli is the unified compliance layer of Smile Omni. It provides a standards-based rules framework that transforms fragmented regulatory interpretation into consistent, transparent, and auditable execution across healthcare programs.
OmniCompli replaces fragmented and disconnected compliance workflows with a single, shared rules foundation. Regulatory and policy requirements are translated into computable, deterministic logic that executes consistently at enterprise scale, ensuring decisions are applied the same way across programs, systems, and partner ecosystems.
Computability removes ambiguity, so systems and teams evaluate information the same way across the enterprise. With a unified, computable compliance foundation, organizations experience:
Consistent Interpretation
Rules execute consistently across programs instead of varying by system or reviewer.
Burden Reduction
Manual review is reduced through deterministic, standards-based automation.
Aligned Quality
Compliance, utilization management, quality, and operations align on one interpretation of policy.
Trust through Transparency
Decisions are transparent, defensible, explainable, and audit-ready.
Ecosystem Consistency
Regulatory updates are applied once and propagated consistently.
Provider and Member Satisfaction
Streamlined workflows enhance care delivery and lower administrative burden.
Meet Regulatory Requirements
Seamless ePA adjudication process that includes CRD, DTR and PAS to accurately adjudicate requests and determine decisions.
Shareability of all member data with in-network providers, including identification modules, proper authorization and secure consent management.
Publicly available PA metrics, details and decisions, with embedded report and audit capabilities.
Automated workflows between payers to enable continuity of care, with security safe-guards, consent modules, ID matching, and secure high-volume data exchange.
Publicly available and searchable provider directory using FHIR-based APIs to make better care decisions.
Trusted by over 30 US Payers, OmniCompli touches 110+ American Lives.
Collaborations with CDC, WHO and CMS on interoperability and regulatory projects.
Innovation Beyond the Mandates
OmniCompli is a unified rules layer built on a fully computable foundation. This single engine powers not only compliance to the upcoming CMS-0057-F mandates, but also real-time prior authorization automations, prospective care gaps management, and continuous quality measures including HEDIS® and MIPS and other downstream use-cases.
Smile Digital Health Reinforces Commitment to Simplify Prior Authorization for Millions of Americans
Solving the Right Problem
Many organizations manage compliance through disconnected systems, manual review, and inconsistent interpretation of regulatory text, clinical guidelines, and organizational policies. These fragmented approaches introduce variability, increase operational burden on Payers, Providers and Members, and create audit risk.
A unified compliance framework reduces risk while increasing speed. By centralizing interpretation and execution, organizations eliminate conflicting logic, reduce operational burden, while increasing transparency and defensibility. This future-ready compliance infrastructure adapts as mandates evolve.
Your organization’s journey to compliance is unique. Whether you need an out-of-the-box product, some basic API integrations to fit within your existing tech stack, or a strategic partner to take you beyond the mandates, OmniCompli can meet you at every step, unlocking valuable insight from your data, and offering enhanced ROI for your compliance investment.
License and deploy compliance-layer solutions your organization needs
Each solution operationalizes regulatory and policy requirements using the same shared rules foundation, ensuring consistent execution across programs.
CMS Suite
The Core Regulatory Compliance Automation
CMS Suite translates CMS interoperability and compliance requirements into deterministic, executable logic. It operationalizes regulatory mandates using standards-based inputs and transparent rule execution, reducing variability caused by manual interpretation.
Includes: FHIR APIs for CDR, DTR, PAS, Payer-to-Payer, Provider Directory and Patient Access.
Who it’s for
Organizations required to meet CMS interoperability and compliance mandates.
Why it matters
It delivers predictable, auditable compliance outcomes aligned to regulatory expectations.
CMS Suite+
Enterprise-scale Compliance Execution
Expand capabilities of CMS Suite to include enterprise-scale automations that require higher throughput, deeper operational alignment, and faster iteration as mandates evolve. CMS Suite+ supports consolidated rule governance across compliance, UMs and quality reporting teams, reducing duplication and overhead, across the organization and network (including in and out of network providers).
Includes: Real-time auditable and defensible Prior Auth Adjudication.
Who it’s for
Enterprises operating multiple, complex regulatory and operational compliance programs, across multi-site networks
Why it matters
Faster adoption and provider/ member satisfaction. In addition, as mandates evolve, significant architectural redesign is minimized.
CMS Concierge
Deliver Managed CMS Compliance Implementation
Pair the CMS Suite solution with OmniConcierge for an operationally ready CMS compliant outcome. Smile experts execute the implementation, hosting, maintenance, and regulatory change management.
Who it’s for
Organizations that need speed, predictability, and operational confidence in meeting CMS mandates before Jan 1st 2027.
Why it matters
It is a cost-effective solution that reduces time to compliance, lowers operational burden, and provides a clear path from managed execution to self-managed capability as internal maturity grows
Compliance Is Now an Operational Capability, Not a Check-list
OmniCompli operates on the trusted data foundation provided by OmniVera and works in concert with OmniConcierge to deliver compliance outcomes that are consistent, explainable, and scalable across the enterprise.
Speak with Our Team
See how OmniCompli powers your modernization strategy with clarity, consistency, and confidence.
Deep Dive with OmniCompli
Read our real-world use case.
Read the Use CaseHow deterministic AI approach can resolve a systemic flaws.
Read the ArticleGet the free downloadable kit to future-proof your compliance investment.
Read the ArticleTested proven PriorAuth solutions delivered.
Watch the VideoCompliance assumptions are risky and expensive.