Changes to Medicare Advantage Network Adequacy Requirements for Behavioral Health Services: What You Need to Know

– by Jocelyn Bayliss, Program Lead, Provider Network Management & Tina Gallagher, Market Manager, Provider Network Management In April 2023, CMS issued a final rule that added two new specialty types, clinical psychology and clinical social work, to network adequacy standards. Addition of Specialty Types and Amendments

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[Webinar Replay] How Providers and Health Plans Can Collaborate to Maximize Revenue and Quality

In this webinar, we discuss the critical role providers play in the success of improved health outcomes, Star ratings, HEDIS measures and risk adjustment. We dive into: – What provider organizations should know about the latest trends in Star ratings, HEDIS measures and risk adjustment – Risk

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Guarding Medicare’s Future: 2025 Proposed Rule to Revolutionize Medicare Advantage Agent and Broker Compensation

– Charles Baker, VP, Compliance Solutions The issue of Medicare Advantage (MA) plans paying administrative fees to field marketing organizations (FMOs) and agents is a hot topic. This is particularly true in light of recent congressional oversight hearings and the newly released 2025 Medicare Advantage Part D

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Navigating the Changing Landscape of Mental Health Parity Compliance: Why Plans Need to Get Ahead of Proposed Rules and Implications

Amanda Brown, Vice President, Compliance Solutions Health plans and issuers need to ramp up compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) in response to the new proposed rules from the Departments of Labor, Health and Human Services. The proposed rules represent a significant

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Navigating Star Ratings in the Aftermath of CMS Plan Preview 2: Actionable Steps for Medicare Advantage Plans in 2023 and Beyond

Charles Baker, VP, Compliance Solutions The recent CMS Plan Preview 2 brought a collective gasp across the Medicare Advantage world. With many healthcare plans still celebrating high Star Ratings from 2022 and 2023, CMS applying the Tukey Method of analysis that resulted in adjusted cut points felt

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