Posts Tagged ‘compliance’
A True End-to-End (E2E) Communications Suite is Essential for Health Plans—Here’s Why…
As Health Plans know well—planning, building, maintaining, and fulfilling accurate mandated member and provider materials requires alignment of all departments and months of coordinating and managing internal and external dependencies and deliverables to meet AEP timelines. Dates like September 30th and October 15th are ingrained in memory, and summers become a head-down race to deliver…
Read MoreProvider Directory Accuracy—Why is it Important?
The Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage plans to post an online provider directory that is up-to-date and accurate. Beneficiaries must be able to use the online provider directory to find contracted providers they can see to receive covered services. Inaccurate provider directories pose risks to beneficiaries. Because members rely on…
Read MoreNew CMS Guidelines for Individuals Not Lawfully Present—Are Your Systems Ready?
Ensuring Member enrollment records are accurate is no easy task. The Centers for Medicare and Medicaid Services (CMS) makes policy changes regularly, and it is up to the individual Health Plans to keep up. Last November, CMS announced in an HPMS memo they would make updates to their policy for Individuals Not Lawfully Present. Effective…
Read MoreWhy Consolidating COB & MSP Data Collections Are Crucial for Health Plan Revenue Recovery & Compliance
The Centers for Medicare and Medicaid Services (CMS) requires MA and PDP health plans to update systems timely and accurately. Consolidating and analyzing COB & MSP data collections while maximizing recovery options and complying with CMS regulations is a challenging task. Incorrect data sets can easily contribute to non-compliance and lead to inaccurate claims payments,…
Read MoreAEP Enrollment Processing Tips—Do’s & Don’ts from End-to-End (E2E)
How well your organization handles a new enrollment during the Annual Enrollment Period (AEP) generally sets the tone for the upcoming contract year for you and your new member. Beginning with Sales and flowing to Enrollment Operations—it’s critical to understand specific actions that trigger reconciliation challenges and member abrasion. With CMS shifting the weight of…
Read MoreHow to Build an Effective Compliance Monitoring Program & Support Ongoing Risk
A monitoring program is an important part of a health plan’s compliance program and provides valuable information to the Compliance Department to ensure the plan is meeting requirements. Effective monitoring requires coordination with operational areas and supports ongoing risk assessment. Monitoring not only provides a mechanism to detect compliance issues throughout the organization but also…
Read MoreHow Can a “Single-Source Solution” Help Manage the Lifecycle of Member Communications?
If you are tasked with the challenge of managing the lifecycle of Member Communications—you likely need an efficient “Single-Source Solution” to help. Managing multiple vendors for document development & creation (ANOCs, EOCs, SBs/SOBs/SBCs, Pre & Post Enrollment materials), translations, Section 508 remediation, directories & formularies, as well as the sourcing of member communications print &…
Read MoreThe Bridge — Volume 12
Madena™ and CODY® Merge to Expand Technology and Consulting Capabilities CODY® Acquires Madena Madena has been acquired by CODY®, a 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…
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 MoreAn Advance Look at Medicare Advantage Benefits Changes for CY2022
Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Plan Benefit Package (PBP) Software that Medicare Advantage (MA) and Part D plans use as part of their bid submissions. The PBP Beta Software is released in late January to allow plans to test and provide feedback before the full version is available…
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