Key Updates in Medicare Parts C & D Appeals, Grievances, and Determinations Guidance
The Centers for Medicare & Medicaid Services (CMS) updated the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals […]
Transforming Healthcare Payer Data Strategies: Leadership’s Role in Driving ChangeÂ
Healthcare payers are navigating a challenging paradox. On one side, technologies like AI, predictive analytics, and real-time data platforms promise
How Healthcare Payers Should Leverage LLM Solutions for Operational Efficiency and Cost Reduction
The healthcare industry is undergoing a rapid digital transformation, driven by advancements in technology and the increasing pressure to improve
Our Key Takeaways from Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2024 Report
The healthcare industry is continuously evolving and with technological advancements, payers seek innovative ways to optimize operations, reduce costs, and
Future-Proofing Healthcare Data: Leveraging Cloud Platforms for Robust Data Protection
In healthcare, data is the primary keeper of information. Data in healthcare has high sensitivity and large volume, so cybercriminals
CMS Reminder to Practice Vigilance Against Medicare Fraud, Waste and Abuse
On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending
Medicare Prescription Payment Plan (M3P) Implementation: Key Considerations for Part D Plan Sponsors and PBMs
The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach
Streamlining Medicare Advantage Organizations Member Communication: A Guide to CMS’s Model Materials for CY 2025
Every year, Medicare Advantage Organizations (MAO)1 must update their member communication materials, such as the Annual Notice of Change (ANOC),
Ensuring Accurate Drug Claims: Insights from CMS Audits and Best Practices
The Centers for Medicare & Medicaid Services (CMS) has added another category of drugs—immunosuppressants—to their national audits in collaboration with
Capitation Rates Announcement for Medicare Advantage Plans for CY 2025
The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025