Medicare
Imagenet Acquires CODY to Create A Comprehensive Suite of SaaS and Services Solutions for Health Plans
Imagenet Acquires CODY to Create A Comprehensive Suite of SaaS and Services Solutions for Health Plans The acquisition will provide health plans serving the Medicare, Medicaid, and Commercial markets with solutions previously unavailable under a single vendor partner JANUARY 14, 2025 TAMPA, FL — Imagenet, a leading digital mailroom, claims adjudication, contact center, and Print-to-EDI…
Read MoreLeading the Medicare Member Materials Creation Process
Now is the time to start getting ready for the upcoming 2025 Annual Enrollment Period (AEP) by identifying your resource needs and planning for system changes. Don’t wait until July to start these activities. CODY’s communications and marketing consultants support health plans by providing experienced, cross-trained experts to assist in project management, variable language, and…
Read MoreCMS Program Audit Prep: Leveraging Your Appeals & Grievances Software
Happy New Year and ‘tis the season for CMS Program Audits! In the 2024 CMS Program Audit Updates memo released on December 19, 2023, CMS confirmed their plans to conduct both routine and focused audits of health plans in 2024. The new focused audits will assess compliance with the coverage and utilization management (UM) requirements finalized…
Read More2024 Oversight Activities – Utilization Management Changes
CMS notified Medicare Advantage Organizations (MAOs) on October 24, 2023, that it will be conducting strategic conversations on the new Utilization Management (UM) requirements effective January 1, 2024. Following these conversations, CMS will start conducting routine and focused audits of the new prior authorization and related rules published in April of this year in the…
Read MoreThe Bridge — Volume 12
Madena™ and CODY® Merge to Expand Technology and Consulting Capabilities CODY® Acquires Madena Madena has been acquired by CODY®, leading healthcare technology and consulting firm. The combined offerings and decades of industry expertise provide Medicare, Medicaid, and Commercial health plans an ‘end-to-end integrated solution’ previously unavailable in the marketplace. CODY® works with over 60 government-funded,…
Read MoreThe Bridge – Volume 11
CMS Important News Releases With a general election, massive increases in COVID-19 cases across the country, and many organizations focusing on the Annual Election Period, you may have missed these important CMS news releases. Advance Notice of Methodological Change for 2022 CMS will calculate 100% of the risk score using the 2020 CMSHCC model (vs.…
Read MoreThe Bridge – Volume 10
We Wish You a Successful and Compliant AEP Season! While we are all in the throes of Annual Enrollment Period (AEP), Madena is looking to support you by dedicating a newsletter to upcoming critical activities that can easily be overlooked during this busy time. CMS Low Income Subsidy Processing Have you reached out to your…
Read MoreMedicare 2021 Timeliness Monitoring Project
In October CMS issued a memo regarding the 2020 Timeliness Monitoring Project (TMP). As in previous years, CMS will once again be conducting an industry-wide monitoring project in 2021. What’s changed? Beginning with the 2021 TMP, CMS will no longer collect the Part D Coverage Determination Appeals and Grievances universes used to evaluate these measures.…
Read MoreCMS Program Audits – Preparation Is Critical
Comprehensive preparation is critical to producing accurate universes and achieving a successful CMS Program Audit. Madena’s experts have dozens of years of experience and can help Part C and D plans with all aspects of the Audit process. How Madena Can Help With Your CMS Program Audit Development and implementation support of universe design – we…
Read MoreMedicare Part C and D Data Validation Audit
Medicare Part C and D Data Validation Audits (DVA) are required by the regulations (42 CFR 422,516, 422.514, CMS-4085-F) implemented by the Centers for Medicare and Medicare Services (CMS). In order to ensure the independence of the Data Validation Audit, organizations cannot use their own staff to conduct it. Instead, Medicare Advantage Organizations (MAO) and…
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