Posts Tagged ‘Reconciliation’
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…
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…
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