Posts Tagged ‘CMS’
Leading 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 MoreAre Your Systems Ready to Properly Process the CMS Annual Coordination of Benefits-Other Health Insurance (COB-OHI) Files?
The CMS Annual COB-OHI process is quickly approaching, and health plans must be prepared to complete mandatory processes to remain compliant. The Centers for Medicare and Medicaid Services (CMS) play a crucial role in ensuring efficient coordination of benefits for individuals with Medicare coverage. The CMS COB-OHI File is an essential resource that facilitates seamless…
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 MoreProposed Change to CMS CY2024 Part C Reporting Requirements – NEW Category Added
CMS Regulatory Change: CMS is proposing an additional Part C reporting requirement for supplement benefits. This is scheduled to be an annual reporting requirement, due the last Monday in February of the following calendar year. Published in the Federal Register Vol. 88, No. 184 on September 25, 2023 and also on the CMS web site,…
Read MoreCMS Model Materials—Changes for CY24
CMS issued the CY24 Model Materials last week Released Model Materials include Annual Notice of Change (ANOC); Evidence of Coverage (EOC); ANOC Errata Notice; EOC Errata Notice; Provider Directory; Part D Explanation of Benefits (EOB); Excluded Provider Model, Formulary (Comprehensive and Abridged); Low Income Subsidy (LIS) Rider; Pharmacy Directory; LIS Premium Summary Table; Prescription Transfer…
Read More2024 AEP – Now is the Time to Prepare!
It may seem early to start preparing for the 2024 Annual Enrollment Period (AEP), but after the Memorial Day holiday, the season comes quickly. Now is the time to prepare by—identifying your resource needs, updating your training programs, and planning for system changes. Don’t wait until July to start these activities; begin now to ensure…
Read MoreIs Your Behavioral Health Network Data—Accurate?
Based on the CY24 Final Rule—the Centers for Medicare & Medicaid Services (CMS) is cracking down on Network Adequacy to improve access to Behavioral Health. In order to build strong Medicare Advantage (MA) Behavioral Health networks that improve timely access to services—CMS is finalizing policies to strengthen network adequacy requirements and reaffirm MA organizations’ responsibilities…
Read MoreCY24 ANOC & EOC Proposed Models—Second Round Available for Comment
A link to the latest CY24 ANOC & EOC proposed models was included in the Federal Register on Friday, April 28, 2023, for a 30-day comment period. Comments are due by May 30, 2023. Proposed CY24 models for the 60-day comment period were published in December 2022. To access the drafts, summary of edits, and…
Read MoreComing Soon – CY24 Model Materials
In May, CMS expects to release the Contract Year (CY) 2024 model materials. These will be posted on the CMS site, CMS Marketing Models, and will include: Annual Notice of Change (ANOC) Evidence of Coverage (EOC) ANOC and EOC standardized model instructions Provider Directory Also expected to be released in May are the CY24 Part…
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