Curious what all the news is about? Here are the basics of Provider Data Validation: What it is and why it's important. Healthcare consumers rely on their insurers to provide comprehensive, current, and accurate information about in-network practitioners. It is critical that this information is accurate the first time a practitioner is added to the... Read more »
Oh, how the times - or in our case, compliance requirements, are changing. The Centers for Medicare & Medicaid Services (CMS) issued its proposed version of the CY 2023 Policy and Technical Changes to Medicare Advantage and Medicare Prescription Drug Benefit Programs rule. Here are the key provisions for the Medicare Advantage (MA) (Part C)... Read more »
On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) issued its proposed version of the Notice of Benefit and Payment Parameters (NBPP) for 2023 rule along with accompanying materials, which include a press release, fact sheet, guidance on payment parameters, a new technical paper on potential risk adjustment model changes, and a... Read more »
New network adequacy standards are in the works. Health Issuers hold on to your hats because the new standards will have a major impact on the way you design, measure and contract your network. Throughout 2021, the Department of Health & Human Services (HHS) has confirmed its plans to transfer oversight of network adequacy for... Read more »
In September, the Department of Health & Human Services (HHS) capped off the back-and-forth debate concerning the Affordable Care Act by publishing its third final rule, “Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond." Many of the changes announced in... Read more »
For all the gains health plans have made in efficiency in recent years, there is one area where middling performance is largely assumed to be inevitable: the lengthy process to fulfill an Employer Group Benefits Response for Proposal (RFP). The problem, of course, is that at the heart of the RFP process is an operational... Read more »
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