They Still Don’t Like It

Debra Devereaux

In the October 8, 2014 memo entitled “Contract Year 2014 Part D Formulary Administration Analysis (FAA)”, CMS reiterates their concern with the accuracy of formulary coding. For the April 2013 analysis, 9 out of 88 (10.2 %) plan sponsors were found to have failed FAA, meaning that greater than 20% of the sampled rejects were determined to be inappropriate. The parameters for the 2014 FAA are: Read more

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Application season is here: How’s your network holding up?

John Nimsky

Once again we are in the midst of application season for health plans applying to become a Medicare …

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The 2015 Ratings are In: Have the Stars Aligned?

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) has released the 2015 Medicare Advantage Star Ratings, and the …

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Part D Rejected Claims Continue to be Important Monitoring for CMS

Wayne Miller

Rejected claim analysis is a year-round activity with special emphasis that should begin before January. Are you confident …

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Marketplaces – Your Stars are coming

Steve Balcerzak

The Centers for Medicare & Medicaid Services (CMS) has been aggressively working in the background to establish the …

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High Value Network: Generation 4.0

John Nimsky

When it comes to healthcare, two truism’s are that medical costs are going up along with demand for …

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Does your current Model of Care coincide with the new requirements?

Peg Novak

The Centers for Medicare and Medicaid Services (CMS) revised the Model of Care (MOC) requirements, reducing core clinical …

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