Are 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…

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Risk Management for Health Plans – Part 3

In Part 2 of our Risk Management for Health Plans series, we provided a high-level understanding of how to approach risk management from a tactical perspective. This week we will provide you with a strategic framework to apply to your  program. The 5 Pillars of Risk Management Keep in mind, Risk Management is a continuous…

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Risk Management for Health Plans – Part 2

In Part 1 of our Risk Management for Health Plans series, we focused on risk culture. This week we will get more tactical and breakdown the operational approach to risk management. Organizational Approach to Identifying & Managing Risk The day-to-day operational approach to risk management requires people, processes, and systems for any organization to properly…

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Risk Management for Health Plans – Part 1

Recently, CODY® conducted, through our partnership with the Association for Community Affiliated Plans (ACAP), a webinar titled Identifying & Managing Risk. These are a few of the questions regarding risk management for health plans that we considered: How effective is your organization at identifying and managing risk within your health plan from an operational and…

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2024 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…

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Is 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…

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CMS Final Rule—CY 2024 Policy and Technical Changes

The Calendar Year 2024 Policy and Technical Changes (CMS Final Rule) was released by the Centers for Medicare & Medicaid Services (CMS) on April 12, 2023. The final rule includes major revisions to regulations governing Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). Some proposed…

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Medicare Secondary Payer (MSP) Processing—What’s Your Revenue Recovery Potential?

Medicare Secondary Payer (MSP) is generally used when another entity is responsible for paying before Medicare. The MSP regulations were put in place to protect Medicare Trust Funds by preventing Medicare funds from being used to pay for items and services that other health insurers are primarily responsible for paying. Primary payers essentially have the…

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CMS’s Plan Benefit Package (PBP) Software—Technical Redesign Coming to HPMS

CMS is modernizing its Plan Benefit Package (PBP) bid submission module for Contract Year (CY) 2024 Going live on April 7, 2023—the new web-based Plan Benefit Package (PBP) Software Technical Redesign will live within the Health Plan Management System (HPMS) and include updates to the user interface and data entry workflow. In previous years, users…

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