CMS in a recent bulletin unveiled a “suite of new resources” aimed at guiding states and CMS in their oversight of Medicaid and CHIP programs, including managed care programs. Two items of particular interest to managed care organizations in a July 6 Center for Medicaid and CHIP Services
Read More →The Centers for Medicare & Medicaid Services (CMS) requires that all health plans have written standards for access to care timeliness and member services. Your health plan is required to: Most states have a standard set requirement for primary and specialty care access and availability. Is your
Read More →Shifts in the managed care landscape have reinforced the need for health plans to engage providers to drive the accuracy of risk scores at the point of care. As health plans and providers adopt value-based reimbursement and risk-sharing models, ensuring the accuracy of risk scores becomes an
Read More →The Supreme Court recently denied a health plan’s petition related to the Centers for Medicare & Medicaid Service’s (CMS) Overpayment Rule, which requires Medicare Advantage (MA) organizations to return identified overpayments to CMS within 60 days. In short, this means that the Overpayment Rule remains in effect and
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