Articles
Why CMS Data Reconciliation Matters for Medicare and Medi-Cal Plans
CMS data reconciliation is more than a technical requirement—it’s a strategic priority. When health plans operate with outdated or misaligned data, the consequences can include lost revenue, member disruption, and increased audit risk. Julie Hughes, Chief Compliance & Consultancy Officer for Imagenet, and Sherrell Johnson, Director of Health Plan Operations at Cody Consulting Group, an…
Read MoreIntroducing CASE – Your pathway to improving reconciliation of enrollment data
Madena is pleased to introduce CASE, a reconciliation and certification process focusing on the enrollment aspect of Medicare compliance to provide a thorough independent assessment of the reconciliation results of MAPDs. CASE was created by leveraging over a dozen years’ of collective Medicare enrollment experience to provide an effective scorecard to improve and enhance the…
Read MoreWebinar: LIS/BAE Best Practices for Part D Sponsors
Are you ready to become an LIS/BAE expert and stop making the same mistakes that have become commonplace in the industry?
Read MorePost-AEP season
Two months have past since the AEP cutoff and I’m wondering how everyone is managing with their annual Reconciliation Review and Retroactive Adjustment work. This is something I would often wondered about every year for the last six years as the Program Director of the Retroactive Processing Contract (RPC). I would wait week after week from January through April until the discrepancies came in to analyze, process, and report back to CMS. Now I am here in the MAPD community in a new capacity and can come right out and ask: How is everyone doing with their Post-AEP Reconciliation Review?
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