A multi-state Medicaid plan faced a competitive bid for contract renewal. The state is moving to mandatory managed Medicaid for its standard Medicaid population as well as dual-eligible and long-term services and supports’ enrollees who need home- and community-based services. It was a substantial rebid with a
Read More →ATTAC’s HHS-RADV analytics and chase approach have helped clients reduce the number of charts they’re chasing for HHS RADV by more than 17% in the past three audit cycles. Honing in on critical charts translates into more efficiency, lower costs, and a better opportunity for reducing error rates for
Read More →Amanda Brown, VP for Compliance Solutions and Anne Crawford, Senior Vice President for Compliance Solutions, will speak at HCCA’s 2023 Virtual Managed Care Compliance Conference. The virtual event is dedicated to compliance management for health plan providers. Jennifer Venditti, Senior Vice President, Business Transformation and Technology and
Read More →Incomplete or inaccurate data from provider claims impacts risk scores Health plans are held accountable for the accuracy of data submitted to CMS. Often, plans act as data aggregators and submit data generated by providers and third-parties to CMS. Incomplete or inaccurate diagnosis data may lead to
Read More →Under guidance issued since Affordable Care Act (ACA) implementation, qualified health plans must provide coverage for specific benefit categories called essential health benefits (EHB). CMS is seeking public comment addressing various aspects of EHB covered by qualified health plans under ACA requirements. Comments must be received by
Read More →The demand for administrative simplification, particularly related to prior authorization, continues to increase On December 15, 2022, the Department of Health and Human Services (HHS) issued a proposed rule for the Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and
Read More →As the plan started to pull together its Mental Health Parity documentation, it became apparent that greater detail would be required to satisfy a state market conduct or federal DOL audit. While the plan understood it had to produce evidence of compliance across many aspects of its
Read More →Building on previous interoperability regulations, CMS on Dec. 13 published a proposed rule that seeks to improve the efficiency and transparency of prior authorization processes in Medicare Advantage and other federally funded health care programs. Industry experts say the rule should ultimately speed access to care, potentially
Read More →Are you prepared for your health plan’s next big project? Do you have the skills and time to tackle the project? As you consider these questions, here are five key considerations that contribute to the success of any project. 1. Ensure that everyone understands the project or program
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