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 When health plans operate with outdated or misaligned data, the consequences can include lost revenue, member disruption, and increased audit risk.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 Imagenet company, will speak on this topic at the upcoming California Association of Health Plans (CAHP) event, Medicare in California: Insights & Shifting Marketing Dynamics, taking place May 13, 2025, in Burbank, CA.

In advance of the session, they’ve co-authored a blog that explores:

• The financial impacts of unreconciled files, including capitation reductions and premium revenue loss
• How inaccurate OHI data can lead to delayed care, denials, and member grievances
• Steps plans can take to implement structured reconciliation processes
• The increasing role of oversight in CMS one-third financial audits
• Why Medi-Cal plans should apply Medicare reconciliation best practices to stay compliant and protect member experience

Read the full blog on the Imagenet website to explore these insights and learn how we’re helping plans strengthen their reconciliation strategy.