Partners Needed

Debra Devereaux

I calculated the total amount of civil monetary penalties (CMPs) levied by the Centers for Medicare & Medicaid Services (CMS) last year on Medicare Advantage and Part D plans, and it’s a big number: $4,925,150. There were also five suspensions in 2014.

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The Model of Care: More than Just a Technical Requirement

Melissa Smith

The Model of Care (MOC) represents the backbone of a health plan’s operational infrastructure and offers powerful potential …

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Marry Data to Build Accurate Customer Profiles

Mary Kaye Thibert

Have you ever played “Pin the Tail on the Donkey” as a kid and found yourself laughing when …

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Is the “NUNCMO” Nightmare Keeping You Up at Night?

Christine Tobin

The recent MAPD Help Desk Memo, dated 3/3/15, advises that on March 8, 2015, “The Centers for Medicare …

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Network Adequacy Test Submissions for Medicare-Medicaid Plans

Elena Martin

In follow up to the October 2014 Health Plan Management System (HPMS) memo titled “MMP Network Adequacy Standards,” …

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The Annual Full Replacement COB Files Are on Their Way

Christine Tobin

It’s that time of year again when Part D plans will receive full replacement Coordination of Benefits (COB) …

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Key Changes to Star Ratings from 2016 Draft Call Letter

Melissa Smith

Now that the news from last month’s 2016 Advance Notice (also known as “the Call Letter”) from the …

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