Posts Tagged ‘Medicare Advantage’
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 MoreRisk 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…
Read MoreRisk 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…
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 MoreRisk 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…
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 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 MoreCMS 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…
Read MoreMedicare 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…
Read MoreCMS’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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