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# ATTAC Consulting Group

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## Posts

- [Maximizing Risk Adjustment Success in the Second Half of 2023](https://www.attacconsulting.com/maximizing-risk-adjustment-success-in-the-second-half-of-2023-four-steps-for-health-plans-to-take-now/) - As we count down to the third quarter, it's time for plans to review year-to-date progress against 2023 risk adjustment roadmaps and determine if any course corrections are needed. Here are four proactive steps health plans should take now to avoid the frenzied fourth-quarter push: Evaluate completion rates for in-home, in-office and telehealth assessments during
- [How to Achieve a High-Performing Risk Adjustment Member Engagement Strategy: 4 Steps to Take Now](https://www.attacconsulting.com/how-to-achieve-a-high-performing-risk-adjustment-member-engagement-strategy-4-steps-to-take-now/) - A high-performing risk adjustment member engagement program is crucial for healthcare organizations to accurately assess and document the health status of members.
- [Medicare-Medicaid Plans to Undergo Performance Measure Validation for 2023 Cycle ](https://www.attacconsulting.com/medicare-medicaid-plans-to-undergo-performance-measure-validation-for-2023-cycle/) - Medicare-Medicaid plans (MMPs) report monitoring and performance measures consistent with the three-way contracts with states, the Medicare-Medicaid capitated financial alignment model core reporting requirements, and state-specific reporting requirements. For the 2023 performance measure validation (PMV) cycle (covering data reported for the 2022 measurement year), CMS will select a subset of MMPs to undergo validation to
- [Section 6220 and the Provider Directory Comment Period: What Health Plans Need to Know](https://www.attacconsulting.com/section-6220-and-the-provider-directory-comment-period-what-health-plans-need-to-know/) - CMS is collecting comments on new Medicare Advantage provider directory rules under Section 6220. Comments due June 29. Here's what's at stake.
- [Your CY2027 MOC Is In. The Work That Decides Whether It Holds Up Starts Now.](https://www.attacconsulting.com/cy2027-model-of-care-requirements-snp/) - CMS raised the bar for CY2027 Model of Care requirements for SNP. Here's what changed, what's at stake before January 1, and how ATTAC helps plans close the gap.
- [The Future of Provider Network Strategy Is Not Gap Identification. It's Gap Prediction. ](https://www.attacconsulting.com/predictive-provider-network-strategy/) - How provider access is changing: turn access surveys into strategic network intelligence that guides action, not just compliance.
- [What It Means to Be a Future-Ready STAR Leader](https://www.attacconsulting.com/future-ready-star-leadership-medicare-advantage-conference-recap/) - Tina Gallagher, former health plan president and provider network expert, shares what emerged from a Future-Ready STAR Leadership roundtable at the 15th Stars, HEDIS & Risk Adjustment Conference in Chicago.
- [CY2027 Final Rule: What Compliance Officers Need to Act On Now](https://www.attacconsulting.com/cy2027-final-rule-what-compliance-officers-need-to-act-on-now/) - CMS released the CY2027 Final Rule. For compliance officers, three areas require action: sales and marketing, SSBCI eligibility, and debit card administration.
- [CY2027 Medicare Advantage Final Rule & Rate Announcement: A Practical Guide Across Six Areas of Change](https://www.attacconsulting.com/cy2027-medicare-advantage-final-rule-rate-announcement-guide/) - CMS released the CY2027 Medicare Advantage Final Rule and Rate Announcement days apart. Here's what changed and what plans must do before the June 1 bid deadline.
- [The Everlasting Audit: Why Peak RADV Audit Season No Longer Exists for MA and ACA Health Plans](https://www.attacconsulting.com/radv-audit-2026/) - The RADV audit 2026 schedule is unlike anything MA and ACA plans have seen. Five cycles. Constant overlap. No off-season. Here's what you need to know.
- [The $17 Billion Reality: Navigating the New Era of MA RADV Enforcement](https://www.attacconsulting.com/ma-radv-audit-brief-2026/) - CMS is initiating PY 2020 RADV audits. Is your health plan ready for the $17B shift?
- [Precision or Penalty: The CY 2027 MOC Shift](https://www.attacconsulting.com/cy2027-snp-moc-guidelines/) - Learn why CY 2027 SNP Model of Care scoring is unforgiving. Meet 100% completion goals for HRAs and ICPs and avoid pitsfalls before the May 2026 deadline.
- [Featured Perspective: Under Pressure](https://www.attacconsulting.com/featured-perspective-regan-pennypacker-under-pressure/) - ATTAC’s Regan Pennypacker breaks down the audit landscape and explains why removing the lens of perception is the first step toward regulatory success.
- [CY 2027 MA Network Adequacy: Navigating New CMS Flexibilities and T&D Shifts](https://www.attacconsulting.com/cy-2027-medicare-advantage-network-adequacy-update/) - CMS has updated operational guidance for CY 2027 Medicare Advantage applications. Learn about accelerated Exception Request timelines, formalized LOI paths, and significant shifts in Time and Distance (T&D) requirements.
- [ATTAC Consulting Group Welcomes Regan Pennypacker as SVP, Compliance Solutions](https://www.attacconsulting.com/regan-pennypacker-svp-compliance-solutions/) - Regan Pennypacker, MSL, CCEP, joins ATTAC Consulting Group as SVP, Compliance Solutions, bringing 25+ years of managed care and government programs expertise.
- [2026-2027 Medicare Advantage Changes: RADV, Stars & Audit Rules](https://www.attacconsulting.com/2026-2027-medicare-advantage-inflection-point-navigating-new-radv-stars-and-audit-rules/) - Navigating 2026-2027 Medicare Advantage changes? Discover key insights on new RADV rules, Star Ratings, and audit protocols in our latest whitepaper.
- [CMS 2027 Proposed Rule: New Provider Termination SEP & Network Impacts](https://www.attacconsulting.com/cms-2027-proposed-rule-new-provider-termination-sep-network-impacts/) - The CMS 2027 Proposed Rule expands the SEP for provider terminations. Discover key impacts on health plan operations, retention, and compliance strategies.
- [The 2026 QHP Survey Cycle Starts Jan 1: Lessons from Year One ](https://www.attacconsulting.com/2026-qhp-survey-cycle-lessons-learned/) - The 2026 QHP survey cycle begins Jan 1. Learn from year one's 47% non-response rates and prepare your provider network strategy now to meet CMS standards.
- [Medicare Plan Finder 2027 Rule: How to Prepare for CMS’s New Provider Directory Accuracy Requirements](https://www.attacconsulting.com/cms-plan-finder-2027-provider-directory-requirements/) - CMS will require Medicare Advantage plans to publish provider directories on Plan Finder by 2027. Learn what to do now to stay compliant.
- [CY 2027 NOIA Deadlines and Guidance](https://www.attacconsulting.com/cy-2027-noia-deadlines-and-guidance/) - CY 2027 Medicare Advantage and Part D NOIA deadlines. Learn key dates and how ATTAC helps plans meet network adequacy standards.
- [Case Study: Retrospective Chart Review](https://www.attacconsulting.com/case-studies-retrospective-chart-review-risk-accuracy/) - A regional health plan increased risk-adjusted revenue by 50% with ATTAC's precision retrospective chart review—improving accuracy and ROI.
- [Federal Court’s Ruling on the CMS RADV Final Rule: What Medicare Advantage Plans Need to Know](https://www.attacconsulting.com/cms-radv-final-rule-vacated-2025-ma-audit-implications/) - A federal court vacated CMS’s 2023 RADV Final Rule, creating uncertainty for Medicare Advantage audits. Learn what plans should do next to stay compliant.
- [Prior Authorization, Financial Fragility, Population Health, and Program Strategy in a Shifting Medicare Landscape](https://www.attacconsulting.com/prior-authorization-medicare-changes/) - Kaiser Family Foundation Research released in August 2025 showed that one in four Medicare beneficiaries lived on less than $24,600 in income in 2024, and half lived on less than $43,200 [1]. Many have little or no savings, with 7.7 million enrollees spending more than 10% of their income on Medicare Part B premiums alone.
- [The No UPCODE Act: Risk Adjustment Reform on Deck](https://www.attacconsulting.com/the-no-upcode-act-risk-adjustment-reform-on-deck/) - Charles Baker, VP, Compliance Solutions Congress may be stuck in partisan stalemates, but risk adjustment reform is one area where the gears are still turning. The No UPCODE Act (S.1105), introduced this spring, has quickly become the focal point for Medicare Advantage payment debates. What’s in the Bill? Chart reviews and HRAs cut out: Diagnoses from chart reviews
- [The Future of Risk Adjustment: Incorporating Social Determinants of Health with the Use of Z Codes](https://www.attacconsulting.com/the-future-of-risk-adjustment-incorporating-social-determinants-of-health-with-the-use-of-z-codes/) - Risk Adjustment | Using Z Codes to Capture Social Determinants of Health
- [Successful UM-Focused Audits: ATTAC Supports Plan Preparation and Remediation](https://www.attacconsulting.com/successful-um-focused-audits-attac-supports-plan-preparation-and-remediation/) - ATTAC’s Experts will help you plan for a UM-focused audit; develop an ongoing monitoring and oversight plan, and assist with necessary remediation post-audits.
- [Key Provisions: 2026 Medicare Advantage & Part D Final Rule](https://www.attacconsulting.com/key-provisions-2026-medicare-advantage-part-d-final-rule/) - Unlike some recent rulemaking cycles, the 2026 final rule does not introduce broad new coverage requirements. Read the full article here.
- [Why the CMS Part C & D Audit Cycle Matters More Than Ever (2024 Edition)](https://www.attacconsulting.com/why-the-cms-part-c-d-audit-cycle-matters-more-than-ever-2024-edition/) - Read full article on what ATTAC's compliance experts are watching: Why the CMS Part C & D Audit Cycle Matters More Than Ever.
- [Podcast | Connecting Quality, Compliance, and Population Health in Managed Care](https://www.attacconsulting.com/podcast-connecting-quality-compliance-and-population-health-in-managed-care/) - In the HEALTHCARE STARcast, host Subbu Ramalingam breaks down the complex world of healthcare to reveal the real strategies and mindsets driving excellence. In this episode, Subbu Ramalingam talks with Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting Group. Charles has worn many hats in the industry, from clinical social work to executive
- [Under the Microscope: CMS Tightens Initial Determinations and Appeals Oversight](https://www.attacconsulting.com/under-the-microscope-cms-tightens-initial-determinations-and-appeals-oversight/) - Charles Baker, VP, Compliance Solutions Tammy Hall, Sr. Consultant, Compliance & Health Plan Operations CMS began a deeper dive into utilization management (UM) for Part C services with the implementation of new UM requirements released in the 2024 Final Rule. On May 30, 2025, CMS raised the red flag indicating a much closer examination of UM
- [Avoid This RADV Coding Mistake Before It Costs You](https://www.attacconsulting.com/avoid-this-radv-coding-mistake-before-it-costs-you/) - CMS is launching the most extensive RADV audit expansion in Medicare Advantage history. Health plans need to move quickly—and smartly—to reduce risk and limit exposure. One of the most common (and costly) mistakes? Contracting with the same vendors used for retrospective coding. Coders trained for retro reviews may bring the same biases to RADV—jeopardizing your audit results.
- [Qualified Health Plan Access Surveys: Were Your Results Actionable—and Did the Timeframe Affect Compliance with CMS and State Requirements?](https://www.attacconsulting.com/qualified-health-plan-access-surveys-were-your-results-actionable-and-did-the-timeframe-affect-compliance-with-cms-and-state-requirements/) - In the 2025 Final Rule, CMS released its expectations and reporting requirements to ensure timely access to care. By the second Friday in June each year, issuers that offer Qualified Health Plans (QHPs)—including stand-alone dental plans—in the federally-facilitated exchanges or the federally-facilitated Small Business Health Options Programs must report secret shopper survey results assessing compliance
- [RADAR on Medicare Advantage | CMS Ramps Up RADV Audit Plans, But Questions Remain About Process](https://www.attacconsulting.com/radar-on-medicare-advantage-cms-ramps-up-radv-audit-plans-but-questions-remain-about-process/) - RADAR on Medicare Advantage, June 5, 2025 Following up on promises to root out fraud, waste and abuse in government-sponsored programs, CMS on May 21 stunned the industry with a bold plan to rapidly expand risk adjustment data validation audits (RADV) used to collect overpayments from Medicare Advantage plans. And on May 30, CMS informed
- [Health Plan Weekly | CMS’s Plan to Audit All MA Plans Brings More Bad News for UnitedHealth, Humana](https://www.attacconsulting.com/health-plan-weekly-cmss-plan-to-audit-all-ma-plans-brings-more-bad-news-for-unitedhealth-humana/) - Health Plan Weekly, May 30, 2025 Amid a flurry of CMS announcements about health care price transparency and Medicaid issues, the agency on May 21 unveiled a bold plan to collect Medicare Advantage overpayments through the expansion of Risk Adjustment Data Validation (RADV) audits. Industry analysts say the news could be especially bad for Humana Inc. and
- [Medicare Advantage RADV Final Rule Changes: With an Expected Audit Recovery of Nearly $5B in Next 10 Years, Will Your Plan Face an Audit?](https://www.attacconsulting.com/medicare-advantage-radv-final-rule-changes-with-an-expected-audit-recovery-of-nearly-5b-in-next-10-years-will-your-plan-face-an-audit/) - The Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit is a vital process conducted by the Centers for Medicare and Medicaid Services (CMS) to ensure the correctness of payments to MA plans. CMS determines monthly payments based on the health and demographic characteristics of each member, as determined by the Hierarchical Condition Category (HCC)
- [Mid-Year Strategy: Aligning Star Ratings and Overall Performance in a Shifting Landscape ](https://www.attacconsulting.com/mid-year-strategy-aligning-star-ratings-and-overall-performance-in-a-shifting-landscape/) - Subbu Ramalingam, Managing Director, ATTAC Consulting Group As we enter the second half of 2025, health plans and provider organizations are approaching a critical strategic inflection point. With the final push to close out 2026 health plan products, HEDIS® seasons and CAHPS® surveys—and the ongoing need for momentum in gap closure and revenue optimization through
- [Federal Communications Pause: CMS Hasn’t Updated Appeals Decisions Since January 20, 2025](https://www.attacconsulting.com/federal-communications-pause-cms-hasnt-updated-appeals-decisions-since-january-20-2025/) - Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN, Sr. Consultant On January 22, 2025, the Department of Health and Human Services was instructed to pause non-essential public communications and website updates. Though framed as a temporary, precautionary measure, this pause has real-world ripple effects on tools that many health plans rely on, including
- [RADAR on Medicare Advantage | Medicare Advantage Experts Point to Member Experience, Provider Contracting as Worthy Investments](https://www.attacconsulting.com/ma-experts-point-to-member-experience-provider-contracting-as-worthy-investments/) - A look at 2024 in Medicare Advantage, including what multiple experts say are keys to success for Medicare Advantage organizations.
- [Qualified Health Plans Secret Shopper Requirements: Do You Have a Process to Survey Your Network and Capture Actionable Analytics by May 31?](https://www.attacconsulting.com/qualified-health-plans-secret-shopper-requirements-do-you-have-a-process-to-survey-your-network-and-capture-actionable-analytics/) - Are You Meeting CMS and State Access-to-Care Requirements? In the 2025 Final Rule, CMS released its expectations and reporting requirements to ensure timely access to care. Effective January 1, 2025, CMS requires issuers that offer Qualified Health Plans (QHPs), including stand-alone dental plans, to take specific actions. These issuers, participating in the federally facilitated Exchanges
- [A New Administration, A New Healthcare Landscape: What Health Plans and Providers Need to Know](https://www.attacconsulting.com/a-new-administration-a-new-healthcare-landscape-what-health-plans-and-providers-need-to-know/) - In 2025, Medicare Advantage may experience positive regulatory changes, while Medicaid and ACA enrollment and rates will be under review. Learn more here.
- [[Podcast] Healthcare Blame Game: Providers, Payers, or Us?](https://www.attacconsulting.com/podcast-healthcare-blame-game-providers-payers-or-us/) - Listen along for a wide-ranging conversation on the Health Elevated podcast. The discussion covers aspects of the healthcare system, including operations, process improvement, financial management, and the role of data science in healthcare innovation. The conversation explores who holds responsibility within the healthcare system—providers, payers, or patients themselves. Prefer video? Watch it here Featuring: Charles
- [RADAR on Medicare Advantage | Despite Trump Transition Chaos, Medicare Advantage Plans Must ‘Keep Calm’](https://www.attacconsulting.com/radar-on-medicare-advantage-despite-trump-transition-chaos-medicare-advantage-plans-must-keep-calm/) - In the first few weeks of Donald Trump’s second presidency, Medicare Advantage plans faced a tremendous amount of uncertainty as the White House threatened to pause federal financial assistance activities, issued multiple executive orders outlining the new administration’s priorities, and targeted diversity, equity and inclusion (DEI) initiatives across departments. HHS also issued a freeze on
- [Regulatory Freeze: How Medicare Advantage Plans Can Balance Challenges with Opportunities for Growth](https://www.attacconsulting.com/regulatory-freeze-how-medicare-advantage-plans-can-balance-challenges-with-opportunities-for-growth/) - Charles Baker, VP, Compliance Solutions President Trump’s executive order to freeze federal regulations has left the healthcare industry, particularly the Medicare Advantage (MA) program, in a state of uncertainty. The freeze, which is intended to align current and proposed rules with the administration’s priority of “reducing the regulatory burden on American businesses and citizens,” has
- [Transform Your HHS-RADV Outcome and Efficiency](https://www.attacconsulting.com/transform-your-hhs-radv-outcome-and-efficiency/) - ATTAC’s HHS-RADV Audit Expertise Delivered for Our Clients in 2024 ✨ Overall Validation Rate: 94.2% 🚫 Overall Non-Validation Rate: 5.8% 🔍 Our Enhanced Audit Efficiencies Include: 📌 >99% claims matching rate 📌 Experienced in-house, on-shore ACA coding team 📌 Dedicated and experienced audit managers 📌 Web-based reporting with dynamic analytics 📌 Optimized chart chase development
- [Important Updates for CMS Calendar Year 2025 Evidence of Coverage (EOC) Models](https://www.attacconsulting.com/important-updates-for-cms-calendar-year-2025-evidence-of-coverage-eoc-models/) - On November 5, CMS updated URLs in the following CY 2025 EOC models: CY2025_1_HMO_MAPD_ISNP_CSNP_EOC_Correcting URLs_11042024 CY2025_2_PPO_MAPD_ISNP_CSNP_EOC_Correcting URLs_11042024 CY2025_3_DE_SNP_EOC_Correcting URLs_11042024 CY2025_4_Cost_Plan_EOC_Correcting URLs_11042024 CY2025_5_PFFS_EOC_Correcting URLs_11042024 CY2025_6_MSA_EOC_Correcting URLs_11042024 CY2025_7_HMO_MA_EOC_Correcting URLs_11042024 CY2025_8_PPO_MA_EOC_Correcting URLs_11042024 CY2025_9_PDP_EOC_Correcting URLs_11042024 The URLs required replacement due to an error in links of the previous models. For example, CY2025_1_HMO_MAPD_ISNP_CSNP_EOC_Correcting URLs_11042024 included these URL corrections: Chapter 3,
- [CMS Announces Updates to Medicare Parts C & D Appeals Guidance Effective January 1, 2025](https://www.attacconsulting.com/cms-announces-updates-to-medicare-parts-c-d-appeals-guidance-effective-january-1-2025/) - Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN CMS has announced significant revisions to Medicare Advantage Part C and Prescription Drug plans. These changes, related to enrollee grievances, organization/coverage determinations, and appeals guidance, will take effect on January 1, 2025 and will affect plans nationwide. The updates aim to enhance clarity, streamline processes,
- [Changes to Medicare Advantage Network Adequacy Requirements for Behavioral Health Services: What You Need to Know](https://www.attacconsulting.com/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 to Access Standards The notice advised that CMS
- [Five Keys to Successful Project Management](https://www.attacconsulting.com/five-keys-to-successful-project-management/) - 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 You’ll need to develop a well-defined charter to
- [[Webinar Replay] Essential Risk Adjustment Insights for 2025-2026: How Plans and Providers Can Stay Ahead of Regulatory Changes and Compliance Challenges](https://www.attacconsulting.com/webinar-essential-risk-adjustment-insights-for-2025-2026-how-plans-and-providers-can-stay-ahead-of-regulatory-changes-and-compliance-challenges/) - Watch ATTAC Consulting Group's risk adjustment experts present an insightful webinar on risk adjustment planning for 2025 and 2026.
- [Case Management's Hidden Role: A Catalyst for Successful Risk Adjustment ](https://www.attacconsulting.com/case-managements-hidden-role-a-catalyst-for-successful-risk-adjustment/) - Here are six ways your plan can tap into this often-overlooked resource that can have a transformative impact on risk score accuracy & health of enrollees.
- [RADAR on Medicare Advantage | CMS Rule Seeks to More Clearly Define Internal Coverage Criteria, AI-Driven Tools](https://www.attacconsulting.com/radar-on-medicare-advantage-cms-rule-seeks-to-more-clearly-define-internal-coverage-criteria-ai-driven-tools/) - December 5, 2024 issue of RADAR on Medicare Advantage Multiple industry experts say the current administration’s last major Medicare Advantage and Part D rulemaking attempt was largely “business as usual,” with CMS expanding on policies of the Joe Biden presidency and digging further into persistent issues like utilization management (UM), misleading marketing and provider directory
- [RADAR on Medicare Advantage | CMS’s $40B GLP-1 Proposal Offers Leeway for Part D Plans to Define Obesity](https://www.attacconsulting.com/radar-on-medicare-advantage-cmss-40b-glp-1-proposal-offers-leeway-for-part-d-plans-to-define-obesity/) - December 5, 2024 issue of RADAR on Medicare Advantage Acknowledging the growing prevalence of obesity in the U.S. and its existence as a chronic disease, CMS in its proposed Medicare Advantage and Part D rule for the 2026 contract year included a landmark provision to expand Medicare and Medicaid coverage of anti-obesity medications (AOMs). The
- [RADAR on Medicare Advantage | Biden Admin Seeks Broader Review of Marketing Materials, But Will Trump Admin See Overreach?](https://www.attacconsulting.com/radar-on-medicare-advantage-biden-admin-seeks-broader-review-of-marketing-materials-but-will-trump-admin-see-overreach/) - Dec 05, 2024 issue of RADAR on Medicare Advantage While the Joe Biden administration has applied many regulatory tweaks to the Medicare Advantage program in the name of improving the consumer experience, industry observers expect the incoming Donald Trump administration will take a more plan-friendly approach from multiple angles. A proposed rule issued on Nov.
- [RADAR on Medicare Advantage | As ‘Focused Audits’ Get Underway, Plans May Struggle to Meet UM Conditions](https://www.attacconsulting.com/radar-on-medicare-advantage-as-focused-audits-get-underway-plans-may-struggle-to-meet-um-conditions/) - Reprinted with AIS Health permission from the 4/4/24 issue of Radar on Medicare Advantage Thanks to a final rule published just one year ago, Medicare Advantage plans as of Jan. 1 were expected to meet new constraints when it comes to applying their utilization management (UM) policies, including prior authorization. CMS has said it aims to
- [Justin Murakami, JD, CHC, Joins ATTAC Consulting as Sr. Consultant for Compliance Solutions](https://www.attacconsulting.com/justin-murakami-jd-chc-joins-attac-consulting-as-sr-consultant-for-compliance-solutions/) - Justin Murakami, JD, CHC, is a highly accomplished healthcare compliance expert with more than 14 years of experience with Medicaid, Medicare, commercial health plans and provider organizations, specializing in California’s complex regulatory landscape. He is known for his leadership in regulatory audits, compliance program development, and risk mitigation for large health plans. At ATTAC Consulting,
- [RADAR on Medicare Advantage | With Extrapolation, OIG Audits Reveal $800M in Medicare Advantage Overpayments](https://www.attacconsulting.com/radar-on-medicare-advantage-with-extrapolation-oig-audits-reveal-800m-in-medicare-advantage-overpayments/) - Nov. 7, 2024 issue of RADAR on Medicare Advantage Based on a review of select diagnosis codes submitted by Medicare Advantage plans for risk-adjusted reimbursement dating back to 2015, the HHS Office of Inspector General (OIG) estimates that 34 MA contracts received at least $801.3 million in overpayments from the federal government, according to an
- [Victoria Nadzam, MSN, RN, Joins ATTAC Consulting Group as Sr. Consultant For Compliance Solutions](https://www.attacconsulting.com/victoria-nadzam-msn-rn-joins-attac-consulting-as-sr-consultant-for-compliance-solutions/) - Victoria Nadzam, MSN, RN, is an accomplished healthcare professional with expertise in clinical operations management, process and performance improvement, and accreditation and regulatory compliance. She has a proven track record of driving compliance with NCQA standards and optimizing healthcare delivery across diverse sectors, including Medicare, commercial ACA, and Medicaid. With Victoria’s background in clinical excellence,
- [Jennifer Eidam Joins ATTAC Consulting Group as VP, Business Development](https://www.attacconsulting.com/jennifer-eidam-joins-attac-consulting-group-as-vp-business-development/) - Jennifer Eidam is a seasoned sales professional with extensive experience in healthcare, SaaS, and pharmaceutical industries. In her years of working with payers, she has demonstrated exceptional leadership and business development skills. In her role with ATTAC Consulting Group, Jennifer provides tailored, strategic guidance to clients, helping payers and providers optimize operations and achieve growth.
- [Kenneth (Kenny) McNeal Joins ATTAC Consulting Group as SVP and Chief Revenue Officer](https://www.attacconsulting.com/kenneth-kenny-mcneal-joins-attac-consulting-group-as-svp-and-chief-revenue-officer/) - Healthcare Industry Leader Brings Decades of Expertise in Healthcare Payer Solutions and Strategic Growth ANN ARBOR, MI (Sept. 30, 2024) – ATTAC Consulting Group announced today that Kenneth McNeal has joined the firm as an SVP and Chief Revenue Officer. ATTAC is a national healthcare consulting firm that provides solutions to Medicare Advantage, Medicaid, and commercial
- [2025 Medicare Advantage Reforms: A Comprehensive Shift Towards Equity, Transparency and Patient-centered Care](https://www.attacconsulting.com/2025-medicare-advantage-reforms/) - Discover key insights on the 2025 Medicare Advantage reforms, including coverage, benefits, and enrollment changes. Make better healthcare decisions!
- [[Webinar Replay] CMS 2025 Final Rule & Mental Health Parity: Regulatory Changes Providers & Plans Need to Know](https://www.attacconsulting.com/free-webinar-cms-2025-final-rule-proposed-mental-health-parity-rule-regulatory-changes-providers-plans-need-to-know/) - Catch the webinar replay for expert insights on impacts of the CMS Final Rule. We discuss: Mental Health Parity | Significant changes will impact provider network operations and reimbursement. Provider Network Requirements | Tightened network adequacy standards are intended to ensure that plans provide beneficiaries with timely access to a sufficient number of providers to meet Medicare
- [Stay Ahead of Mental Health Parity Audit Risks with Updated Benefit Documents](https://www.attacconsulting.com/stay-ahead-of-mental-health-parity-audit-risks-with-updated-benefit-documents/) - It's crucial for health plans and plan sponsors to verify the accuracy and timeliness of benefit documents, such as Certificates of Coverage, Summary Plan Descriptions, and Evidence of Coverages, as they finalize annual changes to benefit plan designs. Some plans have discovered during audits by a Department of Labor, CMS, or a Department of Insurance,
- [Navigating the Changing Landscape of Mental Health Parity Compliance: Why Plans Need to Get Ahead of Proposed Rules and Implications](https://www.attacconsulting.com/navigating-the-changing-landscape-of-mental-health-parity-compliance-why-plans-need-to-get-ahead-of-proposed-rules-and-implications/) - Health plans and issuers need to ramp up Mental Health Parity in response to new proposed rules
- [Medicaid and CHIP Provider Access Survey Requirements: Are You Ready to Meet CMS and State Access to Care Requirements in Plan Year 2025?](https://www.attacconsulting.com/medicaid-and-chip-provider-access-survey-requirements-are-you-ready-to-meet-cms-and-state-access-to-care-requirements-in-plan-year-2025/) - By Jocelyn Bayliss The 2025 Final Rule from CMS outlined expectations and reporting requirements related to timely access to care. Effective PY 2025, CMS requires that all states with Medicaid and the Children’s Health Insurance Program (CHIP) develop, conduct, and enforce independent secret shopper surveys to evaluate compliance with appointment wait time standards. States are
- [[Webinar Replay] Navigating the Telephone Consumer Protection Act for Healthcare Organizations](https://www.attacconsulting.com/webinar-replay-navigating-the-telephone-consumer-protection-act-for-healthcare-organizations/) - ATTAC and mPulse co-presented this comprehensive webinar and discussion that aims to empower attendees to: Debunk myths related to the TCPA, consent, and the healthcare exemption Get the background on the TCPA’s purpose, history, terminology, and requirements Understand existing and recent TCPA litigation related to the healthcare ecosystem, including the impact of the Supreme Court
- [Enhancing Provider Engagement: 9 Best Practices for Optimizing In-Office Assessments for Risk Adjustment](https://www.attacconsulting.com/enhancing-provider-engagement-9-best-practices-for-optimizing-in-office-assessments-for-risk-adjustment/) - by Jon Rogers, Sr. Consultant, Risk Adjustment As the fourth quarter approaches, managed care organizations (MCOs) should focus on optimizing their risk adjustment in-office assessment (IOA) processes to ensure accurate patient assessments, which are crucial for both appropriate revenue realization and quality care management. The following comprehensive action plan outlines nine best practices that will
- [Looking Ahead to the Next Veteran Affairs Community Care Network RFP: Prepare Now to Meet the Demands of a Substantial Network Build](https://www.attacconsulting.com/looking-ahead-to-the-next-veteran-affairs-community-care-network-rfp-prepare-now-to-meet-the-demands-of-a-substantial-network-build/) - The Veteran Affairs Community Care Network (VA CCN) is a program that allows veterans to get healthcare services in their communities instead of having to go to a VA facility. It connects veterans with local healthcare providers who have agreements with the VA. The goal is to make it easier and faster for veterans
- [The Roller Coaster Continues: Preliminary Injunction Preserves Field Marketing Organization Compensation Practices For Medicare Advantage and Part D Plans](https://www.attacconsulting.com/the-roller-coaster-continues-preliminary-injunction-preserves-field-marketing-organization-compensation-practices-for-medicare-advantage-and-part-d-plans/) - Charles Baker, VP, Compliance Solutions On July 3, 2024, the U.S. District Court for the Northern District of Texas issued a preliminary injunction, halting the implementation of certain provisions within the CMS Final Rule for Contract Year 2025. This rule aimed to overhaul the compensation arrangements between health plans and Field Marketing Organizations (FMOs), particularly
- [Five Steps Managed Care Orgs Can Take Now to Improve Member Engagement](https://www.attacconsulting.com/five-steps-to-improve-member-engagement/) - by Jon Rogers, Sr. Consultant, Risk Adjustment As we move through the second half of 2024, managed care organizations must prioritize member engagement, especially for individuals with chronic conditions. This period presents an opportunity to embrace strategies that encourage essential healthcare visits, such as annual wellness and primary care appointments. Read on for member engagement
- [Ensuring Network Adequacy: What Medicare Advantage Plans Need to Know About CMS's New Rules](https://www.attacconsulting.com/ensuring-network-adequacy-what-medicare-advantage-plans-need-to-know-about-cmss-new-rules/) - CMS has implemented significant regulatory changes to network adequacy standards that require Medicare Advantage (MA) plans to quickly adapt to ensure compliance. Read on for an overview of the necessary steps plans must take to meet these new requirements. Convert Letters of Intent. Health plans that submitted Letters of Intent (LOIs) to fulfill network adequacy
- [How MCOs Can Optimize In-Home Health Assessment Programs: What You Need to Know for the Second Half of 2024](https://www.attacconsulting.com/how-mcos-can-optimize-in-home-health-assessment-programs-what-you-need-to-know-for-the-second-half-of-2024/) - by Jon Rogers, Sr. Consultant, Risk Adjustment As we reach the midpoint of 2024, managed care organizations (MCOs) must take a close look at their In-Home Health Assessment (IHHA) programs, which play a critical role in managing the health of Medicare Advantage and Affordable Care Act populations. These assessments, running from January 1 to December
- [Notification of Supplemental Benefits and Data Integrity: How Will CMS 2025 Final Rule Requirements Affect Your Medicare Advantage Plan?](https://www.attacconsulting.com/notification-of-supplemental-benefits-and-data-integrity-how-will-cms-2025-final-rule-changes-affect-your-medicare-advantage-plan/) - Charles Baker, VP, Compliance Solutions and Tammy Hall, Senior Consultant, Compliance Solutions Medicare Advantage (MA) plans offering supplemental benefits have reported enrollee underutilization of many of these benefits. Supplemental benefits may include hearing, dental, vision, fitness programs, over-the-counter drugs, transportation for medical appointments, and other services that address social determinants of health, including food and housing
- [The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies](https://www.attacconsulting.com/the-battle-for-medicare-star-ratings-scan-and-elevance-victories-provide-a-roadmap-for-plans-to-challenge-cms-methodologies/) - By Charles Baker, VP, Compliance Solutions In the world of Medicare Advantage, the calculation of Star Ratings is more than a measure of quality – it’s a pivotal marker that can significantly sway federal funding and market competitiveness. Against the backdrop of high financial stakes and rigorous scrutiny, recent legal victories for SCAN Health Plan
- [Expanded Telehealth Access: Powerful Medicare Rule Changes Impact Access, Health Equity and Risk Scores](https://www.attacconsulting.com/expanded-telehealth-access-powerful-medicare-rule-changes-impact-access-health-equity-and-risk-scores/) - by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment Telehealth has been around for decades, but the COVID-19 pandemic thrust it into the spotlight when patients couldn't see practitioners in-person. Suddenly, telehealth via video, audio, text, and email became a lifeline, one that’s especially beneficial for patients who
- [Deciphering the 2025 Final Rule: CMS Unveils Sweeping Medicare Advantage Changes](https://www.attacconsulting.com/deciphering-the-2025-final-rule-cms-unveils-sweeping-medicare-advantage-changes/) - Charles Baker, VP, Compliance Solutions Read in .pdf here The Centers for Medicare & Medicaid Services (CMS) ushered in a new era for the Medicare Advantage Part C and Prescription Drug Benefit programs with the unveiling of the Contract Year 2025 Final Rule. This comprehensive regulatory overhaul touches on multiple areas, from data privacy and
- [Elevate Your Compliance Training Program: Proven Methods to Measure and Enhance Effectiveness](https://www.attacconsulting.com/elevate-your-compliance-training-program-proven-methods-to-measure-and-enhance-effectiveness/) - Can you relate to this scenario? As a Medicare compliance officer, you’ve just updated your mandatory general compliance and fraud, waste and abuse training. You’re ready to send an email to all employees to launch the training. As your finger hovers over the send button, you wonder: Is this training going to meet the company’s
- [RADAR on Medicare Advantage | Pre-AEP Provider Pushback Offers ‘Reality Check’ For Medicare Advantage Plans](https://www.attacconsulting.com/radar-on-medicare-advantage-pre-aep-provider-pushback-offers-reality-check-for-medicare-advantage-plans/) - AEP, Medicare Advantage Plans, networks and providers
- [RADAR on Medicare Advantage | Risk Scores, Star Ratings Are Catalysts to Watch in Medicare Advantage](https://www.attacconsulting.com/radar-on-medicare-advantage-risk-scores-star-ratings-are-catalysts-to-watch-in-medicare-advantage/) - Reprinted with AIS Health permission from the 1/4/24 issue of Radar on Medicare Advantage 2024 Medicare Advantage Outlook For our annual series of outlook stories on the year ahead in Medicare Advantage, AIS Health, a division of MMIT, spoke with more than a dozen industry experts on the challenges facing MA insurers and the potential strategies
- [Webinar Replay | Value-based Care is a Team Sport: How Providers Can Operationalize Risk Adjustment Initiatives](https://www.attacconsulting.com/webinar-replay-value-based-care-is-a-team-sport-how-providers-can-operationalize-risk-adjustment-initiatives/) - An insightful webinar exploring the power of collaboration between providers and health plans to achieve accurate risk-adjusted compensation. While providers and health plans may have different perspectives, there are numerous synergies and opportunities to use data analytics and drive value for patients. We delve into how providers can develop a robust data strategy by harnessing
- [Dr. Michael Chapman, DO, MHCM, MS, FACOEP, Joins ATTAC Consulting as Clinical Advisor](https://www.attacconsulting.com/dr-michael-chapman-do-mhcm-ms-facoep-joins-attac-consulting-as-clinical-advisor/) - Dr. Michael Chapman, DO, MHCM, MS, FACOEP, is a Clinical Advisor at ATTAC Consulting Group. He is board-certified in emergency medicine, with more than a decade of clinical experience. Dr. Chapman has served as Medical Director for a health plan with more than a million members in commercial, Medicare Advantage and Medicaid products. In his work
- [Breaking Barriers, Bridging Gaps: Collaborative Solutions for Improving Behavioral Health Access and Documentation](https://www.attacconsulting.com/breaking-barriers-bridging-gaps-collaborative-solutions-for-improving-behavioral-health-access-and-documentation/) - by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment CMS recently announced its Innovation in Behavioral Health Model, intended to “improve quality of care, access, and outcomes for people with mental health conditions and substance use disorders in Medicaid and Medicare.” Reducing Barriers to Engage Patients with Behavioral Health
- [The Aftermath of the Change Healthcare Cyberattack: A Call to Action for Health Plans](https://www.attacconsulting.com/the-aftermath-of-the-change-healthcare-cyberattack-a-call-to-action-for-health-plans/) - Charles Baker, VP, Compliance Solutions The recent cyberattack on Change Healthcare affected clinical-decision support, eligibility verifications, chart abstractions, and pharmacy operations, and has highlighted vulnerabilities within the industry's digital infrastructure. In light of these disruptions, plans need to explore the broader implications, particularly concerning Part D, CAHPS, Star Ratings, and the overall operational and financial
- [Dual-Eligible Care Redefined: How to Seize Opportunities in the D-SNP Landscape](https://www.attacconsulting.com/dual-eligible-care-redefined-how-to-seize-opportunities-in-the-d-snp-landscape/) - – Charles Baker, VP, Compliance Solutions The transition of Medicare-Medicaid Plans (MMPs) to Dual-Eligible Special Needs Plans (D-SNPs) by the end of 2025 marks a significant change in healthcare delivery. This shift demands a comprehensive approach due to the complex regulatory ecosystem; it's essential for health plans to understand and align with state-specific Medicaid managed-care arrangements
- [Transforming Dual-eligible Care in California: A Guide to the D-SNP Transition](https://www.attacconsulting.com/transforming-dual-eligible-care-in-california-a-guide-to-the-d-snp-transition/) - Charles Baker, VP, Compliance Solutions The transition from Medicare-Medicaid Plans (MMPs) to Dual Eligible Special Needs Plans (D-SNPs) in California, particularly under the Medi-Cal program, is a pivotal part of a broader shift toward more integrated and coordinated care. This move is a key aspect of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, which
- [Medicare Advantage Risk Adjustment Methodology: CMS Makes Significant Changes to Behavioral Health HCCs](https://www.attacconsulting.com/medicare-advantage-risk-adjustment-methodology-cms-makes-significant-changes-to-behavioral-health-hccs/) - by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment As CMS continues to evolve its Medicare Advantage risk adjustment methodology, significant changes have been made to the behavioral health Hierarchical Condition Categories (HCCs). Starting with the 2024 payment year, the risk adjustment model now employs a blended risk
- [Kevin Barbee Joins ATTAC Consulting Group as SVP for Business Transformation](https://www.attacconsulting.com/kevin-barbee-joins-attac-consulting-group-as-svp-for-business-transformation/) - Barbee has served as a strategic advisor and thought leader for premier national insurers, health plans and provider organizations [Ann Arbor, MI - February 12, 2024] - ATTAC Consulting Group announced today that Kevin Barbee has joined the firm as Senior Vice President for its Business Transformation Group. ATTAC, a national leader in consulting, auditing,
- [New Proposed Medicaid Regulations Aim to Enhance Access to Care & Health Equity | Submit Comments by July 3, 2023](https://www.attacconsulting.com/new-proposed-medicaid-regulations-aim-to-enhance-access-to-care-and-health-equity-submit-comments-by-july-3-2023/) - The proposed rule, Ensuring Access to Medicaid Services, includes changes to existing requirements and introduces new requirements. The proposed regulations advance CMS’s efforts to improve access to care, quality and health outcomes; the regulations are intended to promote health equity across fee-for-service (FFS) and managed care delivery systems, including home and community-based services (HCBS). If
- [Navigating Star Ratings in the Aftermath of CMS Plan Preview 2: Actionable Steps for Medicare Advantage Plans in 2023 and Beyond](https://www.attacconsulting.com/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 like a bucket of cold water. Modeling experts
- [Compliance Isn’t Just Compliance Anymore: Three Ways Medicare Advantage Teams Can Shift From Retrospective Oversight & Deliver Strategic Value ](https://www.attacconsulting.com/compliance-isnt-just-compliance-anymore-three-ways-medicare-advantage-teams-can-shift-from-retrospective-oversight-and-deliver-strategic-value/) - he compliance function has evolved into a strategic partner that adds value beyond oversight.
- [RADAR on Medicare Advantage | With Final RADV Rule Out, MAOs Are Advised to Clean Up Risk Adjustment Practices](https://www.attacconsulting.com/radar-on-medicare-advantage-with-final-radv-rule-out-maos-are-advised-to-clean-up-risk-adjustment-practices/) - Medicare Advantage organizations may not have gotten the outcome they were hoping for in CMS’s recently finalized Risk Adjustment Data Validation rule, but industry experts say they weren’t surprised by the position CMS ultimately took after years of pressure to close out RADV audits and recover identified overpayments. And while one aspect of the rule
- [[Webinar Replay] How Providers and Health Plans Can Collaborate to Maximize Revenue and Quality](https://www.attacconsulting.com/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 adjustment claw-back exposure for health plans and providers
- [Guarding Medicare's Future: 2025 Proposed Rule to Revolutionize Medicare Advantage Agent and Broker Compensation](https://www.attacconsulting.com/guarding-medicares-future-2025-proposed-rule-to-revolutionize-medicare-advantage-agent-and-broker-compensation/) - Newly released 2025 Medicare Advantage Part D proposed rule aims to enhance guardrails for agent and broker compensation
- [Harnessing the Power of Data: Integrating HEDIS, Risk Adjustment and Social Determinants of Health for Effective Population Health](https://www.attacconsulting.com/harnessing-the-power-of-data-integrating-hedis-risk-adjustment-and-social-determinants-of-health-for-effective-population-health/) - – by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment Leading healthcare organizations are developing strategies to align their programs and streamline the process of gathering crucial data to better serve beneficiaries. With the goal of achieving population health, managed care organizations must fundamentally understand members’ needs and
- [Take These Four Steps For a Successful Provider Engagement Strategy That Drives Value-based Reimbursement](https://www.attacconsulting.com/take-these-four-steps-for-a-successful-provider-engagement-strategy-that-drives-value-based-reimbursement/) - Implementing the right strategy, approach, and program for each provider and payer scenario is critical to deliver sustained success.
- [Telehealth Fraud, Waste and Abuse: How to Develop a Prevention and Detection Program](https://www.attacconsulting.com/telehealth-fraud-waste-and-abuse-how-to-develop-a-prevention-and-detection-program/) - Learn how plan sponsors should address telehealth fraud as part of overall anti-fraud, waste, and abuse plans.
- [Radar on Medicare Advantage | New Prior Authorization Rule Aims to Quicken Senior Access to Care](https://www.attacconsulting.com/radar-on-medicare-advantage-new-prior-authorization-rule-aims-to-quicken-senior-access-to-care/) - 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 alleviating some but not all of the concerns
- [Is Your Plan Ready for Medicaid Redetermination? ](https://www.attacconsulting.com/is-your-plan-ready-for-medicaid-redetermination/) - As required by CMS, each state is developing its plans for the 12-month unwinding period in anticipation of the end of the public health emergency (PHE). On October 13, 2022, the U.S Department of Health and Human Services announced the renewal of the PHE, extending it an additional 90 days. The renewal will allow states
- [Charles Baker Joins ATTAC Consulting Group as Vice President of Compliance Solutions](https://www.attacconsulting.com/charles-baker-joins-attac-consulting-group-as-vice-president-of-compliance-solutions/) - Charles Baker Joins ATTAC Consulting Group as Vice President of Compliance Solutions
- [Closing the Gap: Strategies to Advance Health Equity and Reduce Health Disparities](https://www.attacconsulting.com/closing-the-gap-strategies-to-advance-health-equity-and-reduce-health-disparities/) - – by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment The CDC defines Health Equity as the state in which everyone has a fair and just opportunity to attain their highest level of health. Despite progress, health disparities remain a persistent issue according to the NIH Common Fund,
- [Get Ready: 2024 Low-Income "Extra Help" Subsidy Changes ](https://www.attacconsulting.com/get-ready-2024-low-income-extra-help-subsidy-changes/) - Health plans should now prepare to implement changes, including developing member retention and acquisition strategies To improve access and affordability of prescription drugs for low-income beneficiaries, the Inflation Reduction Act of 2022 eliminated the partial low-income subsidy (LIS) benefit beginning in 2024. This change will move Medicare beneficiaries with incomes between 135% and 150% of the
- [The Dynamic Duo: Understanding the Link Between Risk Adjustment and Quality Measurement](https://www.attacconsulting.com/the-dynamic-duo-understanding-the-link-between-risk-adjustment-and-quality-measurement/) - CMS launched the National Quality Strategy, a long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals.
- [Navigating Utilization Management Criteria Changes: A Call to Action for Compliance Officers](https://www.attacconsulting.com/navigating-um-criteria-changes-a-call-to-action-for-compliance-officers/) - The HPMS memo released yesterday is a significant signal for changes to come, especially when viewed through the lens of the 2024 MAPD Final Rule (CMS-4201-F) and the recently released 2024 Readiness Checklist. It’s a call to action for all compliance officers and Utilization Management (UM) departments to unite and upgrade practices in line with
- [Provider Access & Availability Surveys: Is Your Plan Meeting Access to Care and Appointment Availability Requirements?](https://www.attacconsulting.com/provider-access-availability-surveys-is-your-plan-meeting-access-to-care-and-appointment-availability-requirements/) - 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: Set written standards for providers that meet or exceed those created by CMS Advise first-tier and downstream providers of the standards Continuously monitor provider network
- [Case Study | How ATTAC Helped a Large Multi-state Health Plan Win a Medicaid Bid by Expanding the Plan’s Provider Network](https://www.attacconsulting.com/case-study-how-attac-helped-a-large-multi-state-health-plan-win-a-medicaid-bid-by-expanding-the-plans-provider-network/) - 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 lot at stake. The plan operates in a
- [2024 Proposed Rule Changes: Impacts to Medicare Advantage & ACA Provider Directories and Contracting](https://www.attacconsulting.com/2023-proposed-rule-changes-impacts-to-medicare-advantage-provider-directories-and-contracting/) - CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications.
- [How to Prepare Your Medicare Advantage Initial or Service Area Expansion Application for CY 2024 & Beyond](https://www.attacconsulting.com/how-to-prepare-your-medicare-advantage-initial-or-service-area-expansion-application-for-cy-2024-beyond/) - CMS requires applicants to demonstrate they have a sufficient network of contracted providers before an initial or service-area expansion application is approved. In addition, for CY 2024, CMS will adopt regulations explicitly permitting it to deny applications based on an applicant’s failure to meet network adequacy criteria. Plans have already begun submitting Health Service Delivery (HSD)
- [Medicare Advantage Initial or Service Area Expansion Application: Finalize CY 2024 and Prepare for CY 2025 ](https://www.attacconsulting.com/medicare-advantage-initial-or-service-area-expansion-application-finalize-cy-2024-and-prepare-for-cy-2025/) - Per the CY 2023 Final Rule published on May 9, 2022, CMS requires applicants to demonstrate a sufficient network of contracted providers to care for beneficiaries before approving their application. Additionally, for CY 2024, CMS adopted regulations explicitly stating that applications may be denied if network adequacy criteria are not met. For CY 2024 applications,
- [Six Ways Your Plan Can Use Case Management For a Transformative Impact on Risk Score Accuracy and Overall Health of Enrollees](https://www.attacconsulting.com/six-ways-your-plan-can-use-case-management-for-a-transformative-impact-on-risk-score-accuracy-and-overall-health-of-enrollees/) - The success of any healthcare organization hinges on its ability to consolidate resources, share knowledge among teams, and promote collaboration. In one example of collaboration for the greater good, let’s explore the crucial role of case management in risk adjustment. Here are six ways your plan can tap into this often-overlooked resource that can have
- [Unlocking Efficiency: Five Ways Monitoring Average Retrieval and Coded Chart Rates Boosts Your Chart Review Program](https://www.attacconsulting.com/unlocking-efficiency-five-ways-monitoring-average-retrieval-and-coded-chart-rates-boosts-your-chart-review-program/) - The metrics related to the average number of retrieved charts and coded charts per unit of time (day, week or month) are crucial for effective project planning and successful completion of any retrospective chart review program. By monitoring these metrics, managed care organizations can gauge the efficiency of retrieval and coding processes, allocate appropriate resources
- [RADAR on Medicare Advantage | New CMS Bulletin Could Mean Greater Oversight of Medicaid Network Adequacy](https://www.attacconsulting.com/radar-on-medicare-advantage-new-cms-bulletin-could-mean-greater-oversight-of-medicaid-network-adequacy/) - 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 Informational Bulletin (CIB) are templates that provide a standard
- [CMS Training for Part D Formulary & Benefit Administration Validation Audits](https://www.attacconsulting.com/cms-training-for-part-d-formulary-benefit-administration-validation-audits/) - On July 27, 2023, CMS released the HPMS memorandum “Announcement of the Part D Formulary and Benefit Administration Validation Audit” which will impact Medicare Advantage Prescription Drug Plans. The CMS training is presented by the Medicare Part C and D Oversight and Enforcement Group, Division of Audit Operations. It’s focused on Formulary Administration (FA) due
- [CMS Strengthens Its Commitment to Health Equity With Finalized Enrollment Guidance ](https://www.attacconsulting.com/cms-strengthens-its-commitment-to-health-equity-with-finalized-enrollment-guidance/) - CMS took a significant step towards advancing health equity with the finalization of Parts C and D Enrollment Guidance. This aligns with CMS's ongoing commitment to prioritize health equity.
- [CMS 2022 Part C and Part D Program Audit and Enforcement Report](https://www.attacconsulting.com/cms-2022-part-c-and-part-d-program-audit-and-enforcement-report/) - Foreword from report issued July 18, 2023 by CMS' Medicare Parts C and D Oversight and Enforcement Group: Read full report here The Medicare Parts C and D Oversight and Enforcement Group (MOEG) in the Centers for Medicare & Medicaid Services (CMS) has historically released an annual report summarizing information from its annual Part C
- [No-cost Risk Adjustment Summary Assessment For Health Plans | Reduce the Risk, Cost & Aggravation of an OIG Audit](https://www.attacconsulting.com/no-cost-risk-adjustment-summary-assessment-for-health-plans-reduce-the-risk-cost-aggravation-of-an-oig-audit-2/) - The Department of Health and Human Services, Office of Inspector General (OIG) continues to actively audit Medicare Advantage Risk Adjustment programs, with a focus on diagnosis codes at "high risk of being miscoded." Between Feb. 2021 and May 2023, OIG issued 25 audit reports that uncovered significant issues. Key findings from 25 OIG Risk Adjustment
- [OIG's Expanded Oversight of Medicare Advantage Risk Adjustment: Implications for Managed Care Organizations ](https://www.attacconsulting.com/oigs-expanded-oversight-of-medicare-advantage-risk-adjustment-implications-for-managed-care-organizations/) - Since 2021, the OIG has issued 24 audit reports, and four of the reports have been published so far in 2023. These audits identified more than $400 million in overpayments, with approximately 72% of audited HCCs not validated / supported within the medical documentation The Office of the Inspector General (OIG) has recently presented at
- [Navigating the 2023 CMS Program Audit: Are You Ready?](https://www.attacconsulting.com/navigating-the-2023-cms-program-audit-are-you-ready/) - CMS has initiated routine program audits by sending engagement letters to Medicare Advantage organizations, prescription drug plans and Medicare-Medicaid plans. Are You Audit-Ready? If your plan receives an engagement letter, are you prepared to respond within 15 business days, or do you feel nervous and hope you won't be selected? CMS program audits are a
- [How to Prepare for Medicaid Redetermination](https://www.attacconsulting.com/how-to-prepare-for-medicaid-redetermination/) - States begin Medicaid redetermination efforts on April 1, 2023 States will start Medicaid redetermination efforts on April 1, 2023. The Consolidated Appropriations Act, 2023 effectively terminated previous requirements that the redetermination period would begin at the end of the Public Health Emergency. If states meet the requirements, they’ll continue to receive federal funding that will decline
- [8 Best Practices for In-Home Assessments: How to Ensure Quality Patient Care & Compliance with Medicare Regulations](https://www.attacconsulting.com/8-best-practices-for-in-home-assessments-how-to-ensure-quality-patient-care-compliance-with-medicare-regulations/) - In-home care plays an important role within the US healthcare system. When done correctly, an in-home assessment provides a comprehensive overview of a patient's health status, which is vital to identify potential health risks and can help ensure optimal outcomes for members who are unable to receive care in a clinic or provider’s office. Recently,
- [Updated Notice of Denial of Medical Coverage / Integrated Denial Notice](https://www.attacconsulting.com/updated-notice-of-denial-of-medical-coverage-integrated-denial-notice/) - Plans should begin using the updated IDN no later than May 2, 2023 CMS updated an Office of Management and Budget-approved standardized Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN). Medicare health plans, including Dual-Eligible Special Needs plans (DSNPs), issue the IDN to inform enrollees of appeal
- [Better Experiences, Better Outcomes:  Understanding the Impacts of 2023 Managed Care Final Rule on Special Needs Plans & Members](https://www.attacconsulting.com/better-experiences-better-outcomes-understanding-the-impacts-of-2023-managed-care-final-rule-on-special-needs-plans-members/) - Highlights from HCCA 2023 Managed Care Compliance Conference Presentation by Anne Crawford, ATTAC Consulting Group | Sandra J. Durkin, Strategic Health Law MA Final Rule: D-SNP & Dual Eligible Provisions Improving experiences for dual-eligible individuals D-SNP implementation timeline Finalized proposals that apply MMP features to D-SNPs Enrollee Participation in Plan Governance Enrollee advisory committee Enrollee
- [New ICD-10 Code Changes Emphasize Social Determinants of Health](https://www.attacconsulting.com/new-icd-10-code-changes-emphasize-social-determinants-of-health/) - The CDC released ICD-10 code changes that go into effect April 1, 2023. All of the code changes are related to improving the capture of Social Determinants of Health (SDOH) information. There are 42 code changes aimed at improved specificity when documenting SDOH conditions, including classifications of: Financial abuse Maltreatment and neglect Problems specifically related
- [Value-based Insurance Design: Is Your Plan Prepared to Implement Medicare Advantage VBID?](https://www.attacconsulting.com/value-based-insurance-design-is-your-plan-prepared-to-implement-medicare-advantage-vbid/) - If you plan to enter the value-based insurance design (VBID) market, it’s important to understand the goal of the program in order to make decisions on how to structure it. VBID is a strategy that minimizes or eliminates out-of-pocket costs for high-value services in defined patient populations. Medicare Advantage organization (MAO) must understand the essence
- [RADAR on Medicare Advantage | 2023 Outlook: MAOs Mull How to Compete While They Brace for Change, Uncertainty](https://www.attacconsulting.com/radar-on-medicare-advantage-2023-outlook-maos-mull-how-to-compete-while-they-brace-for-change-uncertainty/) - In a sweeping proposed rule for the 2024 contract year, CMS last month took a strong stance on multiple aspects of the Medicare Advantage program, from misleading marketing and prior authorization to quality gains incentivized by the Star Ratings. As plans digest the many changes proposed in that rule, several major unknowns remain that could
- [RADAR on Medicare Advantage | Sweeping MA, Part D Proposed Rule Touches on Everything From Stars to SNPs](https://www.attacconsulting.com/radar-on-medicare-advantage-sweeping-ma-part-d-proposed-rule-touches-on-everything-from-stars-to-snps/) - Exceeding 950 pages in its initial prepublication version, CMS’s most recent rule proposing policy and technical changes for contract year 2024 is the Biden administration’s most complicated and sweeping Medicare Advantage and Part D rule to date. Following a comprehensive request for information issued last summer on various aspects of the MA program, the rule
- [Overpayment Rule Stands: Review Your Plan’s Processes and Procedures Now to Avoid False Claims Act Liability](https://www.attacconsulting.com/overpayment-rule-stands-review-your-plans-processes-and-procedures-now-to-avoid-false-claims-act-liability/) - 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 MA plans must comply or potentially face False Claims
- [HHS Introduces Standards for Healthcare Transactions and Electronic Signatures](https://www.attacconsulting.com/hhs-introduces-standards-for-healthcare-transactions-and-electronic-signatures/) - 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 Authorization Transaction Standards. HHS states “this rule would
- [RADAR on Medicare Advantage | New Third-Party Marketing Oversight Duties Have Industry Scrambling Before AEP](https://www.attacconsulting.com/radar-on-medicare-advantage-new-third-party-marketing-oversight-duties-have-industry-scrambling-before-aep/) - After observing a high volume of marketing-related complaints that the federal government believes are driven by the actions of third-party marketing organizations (TPMOs), CMS this month is implementing several new requirements aimed at protecting Medicare beneficiaries as they compare coverage options during the 2023 Annual Election Period (AEP) that starts on Oct. 15. And while
- [Fierce Healthcare | Medicare Advantage at Tipping Point: A Preview of 2023 Open Enrollment](https://www.attacconsulting.com/fierce-healthcare-medicare-advantage-at-tipping-point-a-preview-of-2023-open-enrollment/) - Medicare Advantage is likely to make up more than half of total Medicare enrollment in 2023 as open enrollment gears up this week. As enrollment surges, plans are facing increased scrutiny over risk adjustment practices, with regulators turning up the heat on payments in the program. Plus, star ratings are set to decline this year

## Pages

- [ATTAC Healthcare Consulting](https://www.attacconsulting.com/) - We're a healthcare consulting firm specializing in operations and healthcare compliance solutions for health insurers and managed care organizations.
- [Provider Network Consulting Opportunities](https://www.attacconsulting.com/provider-network-consulting-opportunities/) - Explore provider network consulting opportunities with ATTAC Consulting Group. We engage independent contractors in provider contracting, network development, and operations.
- [Thought Leadership & Firm News](https://www.attacconsulting.com/news/) - ATTAC Consulting Group is a thought leader in the healthcare industry including medicare advantage compliance and risk adjustment.
- [Careers at ATTAC](https://www.attacconsulting.com/about-acg/careers-at-attac/) - We are always on the lookout for passionate industry experts to help us grow our team.
- [Medicare Advantage RADV Audits](https://www.attacconsulting.com/services-solutions/risk-adjustment/medicare-advantage-radv-audits/) - Prepare for the PY2020 CMS MA RADV audit wave with ATTAC. We coded for 10% of all H-contracts last cycle. Expert HCC validation, V28 transition & audit support.
- [STAR Ratings, Risk Adjustment & Quality Advisory](https://www.attacconsulting.com/services-solutions/services-solutions-star-quality-risk-adjustment/) - STAR/Quality & Risk Adjustment Practice | ATTAC Consulting Group ATTAC CONSULTING GROUP Overview Capabilities AI Readiness Results Leadership Why ATTAC Connect ● STAR/Quality & Risk Adjustment Practice Relentless action. Thoughtful navigation. ATTAC Consulting Group unites expert advisory, proven innovation, and execution focused teams into one practice that drives measurable business results and better health outcomes
- [MA RADV Audit Support](https://www.attacconsulting.com/ma-radv-audit-support/) - CMS initiated PY2020 MA RADV audits March 20, 2026. Validira coded 10% of all PY2019 MA RADV audited H-contracts. Get Con-RADV audit support now.
- [Medical Record Coding & Retrospective Chart Coding](https://www.attacconsulting.com/services-solutions/risk-adjustment/retrospective-chart-coding/) - Retrospective chart coding built by auditors, not a coding factory. 98% accuracy, MA RADV HCC validation, and ACA chart review. Onshore or offshore, ready in 2–3 weeks.
- [CY2027 Medicare Advantage Final Rule & Rate Announcement Briefing](https://www.attacconsulting.com/cy2027-medicare-advantage-final-rule-rate-announcement-briefing/) - CMS released the CY2027 Medicare Advantage Final Rule and Rate Announcement. Get ATTAC's operational briefing on unlinked CRR exclusions, RADV, Stars, and what your team needs to do before June 1.
- [ACA HHS-RADV Audit for Commercial Issuers](https://www.attacconsulting.com/services-solutions/auditing/hhs-radv-audit/) - ATTAC Consulting Group is the leader in performing ACA HHS-RADV audits for national, regional, BCBS, and local commercial product issuers.
- [ATTAC Consulting Group's Leadership and Consulting Team](https://www.attacconsulting.com/about-acg/consulting-team/) - ATTAC's team members deliver highly relevant healthcare industry experience, with years of expertise crafting solutions, to a broad array of clients.
- [Healthcare Compliance Services & Programs](https://www.attacconsulting.com/services-solutions/healthcare-compliance/) - In the increasingly regulated healthcare environment, monitoring compliance is a critical aspect for every health plan and every business process.
- [Case Studies](https://www.attacconsulting.com/case-studies/) - Explore ATTAC case studies showing how we help health plans improve revenue, compliance, and financial performance.
- [Medicare Advantage Consulting For Health Plans](https://www.attacconsulting.com/about/health-plans/medicare-plans/) - ATTAC Consulting is a national leader in advisory, auditing, consulting, technology and business operations solutions to Medicare Advantage and Part D plans.
- [Provider Access & Availability Surveys](https://www.attacconsulting.com/services-solutions/provider-networks/provider-access-surveys/) - ATTAC’s Provider Access & Availability Surveys deliver actionable insights, fix network gaps, and improve compliance, CAHPS, HEDIS, and ROI.
- [CAHP Conference 2025](https://www.attacconsulting.com/cahp-2025/) - Connect with ATTAC at CAHP 2025 Share your contact info to receive a complimentary gift and be entered to win a Yeti Camino bag. We’d love to stay in touch after CAHP 2025. Fill out the form to claim your gift and secure your chance at a Yeti Camino bag. It’s our way of saying
- [About ATTAC Consulting Group](https://www.attacconsulting.com/about-acg/) - ATTAC Consulting Group (ACG) has been recognized as a premier national consulting and auditing firm serving insurers, managed care and provider organizations.
- [Altera/Allscripts Upgrade Project Manager ](https://www.attacconsulting.com/about-acg/careers-at-attac/altera-allscripts-upgrade-project-manager/) - This is a 40 hour/week contract position that will be remote except for go-live activities. ATTAC Consulting Group seeks a skilled Altera/Allscripts Upgrade Project Manager to support 25.1 SCM upgrades. The ideal candidate will have significant experience managing SCM upgrades and/or implementations for large multi-facility healthcare organizations. The PM will be responsible for all project
- [Risk Adjustment Optimization, Strategy & Compliance](https://www.attacconsulting.com/services-solutions/risk-adjustment/risk-adjustment-compliance-optimization-strategy/) - ATTAC Consulting Group's Risk Adjustment Optimization, Compliance and Program Development Services Include Optimization Assessments, RADV support & Data Tracing
- [Provider Network Contracting, Strategy and Development](https://www.attacconsulting.com/services-solutions/provider-networks/provider-network-development/) - ATTAC supports Provider Network Contracting and Development with one of the largest and most experienced contracting teams serving plans & provider groups
- [Mental Health Parity Compliance & NQTL Services](https://www.attacconsulting.com/services-solutions/healthcare-compliance/mental-health-parity-compliance-nqtl/) - ATTAC Consulting Group guides Mental Health Parity NQTL Compliance and QTL Testing. We help insurers, ERISA plans & TPAs test & prepare for DOL or CMS audits.
- [Provider Network Management](https://www.attacconsulting.com/services-solutions/provider-networks/) - ATTAC Consulting Group (ACG) assists organizations in network development , value-based contracting and optimizing relationships between physicians, hospitals and providers.
- [ATTAC Consulting Group Capabilities Brochures](https://www.attacconsulting.com/attac-consulting-capabilities-brochures/) - Firm Overview Business Transformation & Technology Compliance Annual Notice of Change, Evidence of Coverage, Summary of Benefits ATTAC Assurance CMS Medicare Independent Validation Audits CMS Program Audits Compliance Program Effectiveness Annual Reviews Medicare Part D Operations Mental Health Parity Compliance For Health Plans Organization Determination, Appeal, Grievance & Call Classification Provider Network Management Provider Access
- [Marketing and Communications](https://www.attacconsulting.com/services-solutions/healthcare-compliance/marketing/) - ACG helps teams develop effective marketing and communication materials for AEP and OEP and reviews websites and sales materials to meet regulatory standards.
- [Risk Adjustment](https://www.attacconsulting.com/services-solutions/risk-adjustment/) - Medicare Advantage, ACA & Medicaid Risk Adjustment Build Robust Risk Adjustment Programs for Complete, Accurate & Compliant Submission ATTAC’s risk adjustment experts help health plans, insurers and provider organizations implement effective risk adjustment programs for Medicare Advantage, commercial, ACA and Medicaid products. We’re one of the nation’s leading risk adjustment auditors for ACA HHS-RADV audits
- [Compliance Program Effectiveness Review & Audit (CPE)](https://www.attacconsulting.com/services-solutions/auditing/compliance-program-effectiveness-review-audit-cpe/) - ATTAC Consulting Group's Compliance Program Effectiveness Audit and Review, helps MA and Part D Plans get the most of this annual assessment with true insight into plan compliance programs.
- [Delegate Auditing & FDRs](https://www.attacconsulting.com/services-solutions/auditing/delegate-auditing/) - ATTAC Consulting Group (ACG) provides solutions Plans need for delegate oversight and compliance monitoring, including providing FDR auditing
- [Compliance Auditing & CMS Program Audits](https://www.attacconsulting.com/services-solutions/auditing/compliance-auditing/) - ACG has conducted hundreds of audits for Plans across the industry who trust ACG’s knowledge, insight into regulatory focus areas and audit efficiency.
- [Market Conduct Examinations](https://www.attacconsulting.com/services-solutions/auditing/market-conduct-examinations/) - ATTAC Consulting Group assists insurers and health plans in preparing for State Market Conduct Examinations and Audits. Learn more about how we can help you today.
- [Auditing](https://www.attacconsulting.com/services-solutions/auditing/) - Our experienced audit managers and proven audit processes are focused, targeted and efficient. Our audit reports provide plans significant return on investment.
- [Medicare Advantage & Part D CMS Program Audits](https://www.attacconsulting.com/services-solutions/auditing/compliance-auditing/ma-and-part-d-cms-program-audits/) - ATTAC Consulting Group will perform a mock CMS program audit to prepare your plan and every member of your team for an audit.
- [Provider Contracts, Materials & Payment Rates](https://www.attacconsulting.com/services-solutions/provider-networks/services-solutions-provider-networks-provider-contracts-and-materials/) - We offer expert services in provider networks, contracts, and materials management, helping businesses optimize operations and achieve cost efficiencies.
- [Provider Network Access, Data & Operations](https://www.attacconsulting.com/services-solutions/provider-networks/provider-network-operations/) - ATTAC Consulting Group's solutions for Provider Directory Accuracy, Credentialing, Training, Network Adequacy and Interim Staffing and Staff Augmentation
- [Interim Staffing and Training](https://www.attacconsulting.com/services-solutions/provider-networks/interim-staffing-and-training/) - Provider Contracting Executive Provider Contracting Manager Provider Contracting Specialists Provider Operations Director/Manager Provider Operations Specialist Our team of experienced provider network management, provider relations and network operations staff is available for interim placement to support network strategy, management, contracting and provider data management. We also provide interim staff for training and development. Provider Contract Provider Contracting Executive Provider Contracting Manager Provider Contracting Specialists Provider Operations Director/Manager Provider Operations Specialist Our team of experienced provider network management, provider relations and network operations staff is available for interim placement to support network strategy, management, contracting and provider data management. We also provide interim staff for training and development. Provider Contract
- [Value-Based Payment Programs](https://www.attacconsulting.com/services-solutions/provider-networks/value-based-contracting-and-population-health/) - ATTAC Consulting Group's provider network and quality teams assist payers implement Value Based Compensation models and providers evaluate plan VBP initiatives.
- [Provider Access & Availability Surveys](https://www.attacconsulting.com/services-solutions/provider-networks/provider-access-availability-surveys/) - ATTAC helps plans go beyond survey data to offer concrete advice on correcting gaps and ultimately elevating member satisfaction.
- [Qualified Health Plan Secret Shopper Surveys](https://www.attacconsulting.com/services-solutions/provider-networks/provider-network-operations/qualified-health-plan-secret-shopper-surveys/) - Qualified Health Plans Secret Shopper Requirements: Do You Have a Process to Survey Your Network and Capture Actionable Analytics by May 31? In the 2025 Final Rule, CMS released its expectations and reporting requirements to ensure timely access to care. Effective January 1, 2025, CMS requires issuers that offer Qualified Health Plans (QHPs), including stand-alone
- [OIG Risk Adjustment Audits & Overpayments](https://www.attacconsulting.com/services-solutions/risk-adjustment/oig-risk-adjustment-audits/) - OIG Risk Adjustment Audits - ATTAC Consulting Assists Plans to Quantify and Minimize Risk through mock OIG audits and Target Analytics
- [Contact Us](https://www.attacconsulting.com/contact-attac-consulting-group/) - 301 E. Liberty Street, Suite 605, Ann Arbor, MI 48104
- [CMS Utilization Management Focused Audits for Medicare Advantage Plans](https://www.attacconsulting.com/services-solutions/healthcare-compliance/cms-um-focused-audits-for-medicare-advantage-plans/) - ATTAC's Clinical & Compliance experts will help your healthcare plan prepare for a utilization management-focused audit through plan preparation & remediation.
- [Business, Operations & Technology Transformation](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/) - ATTAC's team of experts covers claims, systems, enrollment, appeals, grievances, UM, risk adjustment, SNPs and other core plan operations.
- [Fraud, Waste & Abuse](https://www.attacconsulting.com/services-solutions/healthcare-compliance/fraud-waste-abuse/) - ATTAC Consulting Group (ACG) assists Plans through evaluation of FWA programs, providing guidance on program design and implementation.
- [Pharmacy Solutions & Investigations](https://www.attacconsulting.com/services-solutions/healthcare-compliance/pharmacy-solutions-investigations/) - ATTAC Consulting Group's pharmacy team supports health plans, legal firms and manufactures with Commercial, Medicare Part D, Part B Medicaid and LTC services.
- [CMS Independent Validation Auditor (IVA)](https://www.attacconsulting.com/services-solutions/healthcare-compliance/cms-caps-icars/) - ATTAC Consulting Group provides Medicare Independent Auditor Validation to leading national Medicare plans for IVA audits & Corrective Action support
- [Delegated Entity & FDR Oversight](https://www.attacconsulting.com/services-solutions/healthcare-compliance/delegate-oversight/) - ATTAC Consulting Group (ACG) provides multiple solutions to Plans needing to enhance delegate and FDR oversight and assure compliance.
- [Compliance Programs](https://www.attacconsulting.com/services-solutions/healthcare-compliance/compliance-programs/) - ACG solutions can help your organization implement programs that are essential to maintaining routine compliance and
- [Provider Management & Directory Accuracy](https://www.attacconsulting.com/services-solutions/provider-networks-old/provider-management-directory-accuracy/) - Invalid provider data causes directory inaccuracies and may lead to access-to-care issues. Invalid data may negatively impact your plan’s quality scores or cause your federal and state provider network reporting to be misaligned with provider directories. ATTAC Consulting Group helps solve common drivers of provider data inaccuracies. Our guidance will help your plan improve workflow
- [ANOC, EOC & SB Creation and Quality Review For Small and Large Health Plans](https://www.attacconsulting.com/anoc-eoc-sb-creation-and-quality-review-for-small-and-large-health-plans/) - ATTAC helps large and small health plans create compliant marketing and communications materials, with the experience and attention to detail you need to ensure Annual Notice of Change (ANOC), Evidence of Coverage (EOC) and Summary of Benefits (SB) documents meet CMS requirements. Here’s what you can expect from our expert marketing and communications
- [Our Approach](https://www.attacconsulting.com/about-acg/our-approach/) - ATTAC's guidance is driven by our detailed review and accuracy, which ensures our solutions are robust and compliant in the ever-changing healthcare industry.
- [HPMS Memo Summary | ATTAC Alert](https://www.attacconsulting.com/hpms-memo-summary-attac-alert/) - Never Miss a Regulatory Update: Your Guide to CMS Updates and Deadlines Week of October 30, 2023 Week of October 23, 2023 Week of October 16, 2023 To receive weekly alerts, please check out the ATTAC Assurance Program. You'll get dedicated access to our compliance consultants for regulatory guidance interpretation and operationalization, health plan
- [CMS Audit Universe Testing, Timeliness and Analytics Service](https://www.attacconsulting.com/services-solutions/auditing/compliance-auditing/cms-universe-testing-and-monitoring/) - ATTAC Consulting Group (ACG) is a leader CMS Program Audit Universe Testing, Timeliness Analysis and Evaluation. We offer periodic & subscription CMS Audit Universe test services that give extensive insight into MA and Part D plan performance.
- [Technology Transformation](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/technology-transformation/) - ATTAC brings decades of experience in supporting innovative technology solutions; we take a business-centric approach to technology & implementation activities.
- [Program & Project Management](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/program-project-management/) - ATTAC delivers the program andproject management expertise to help achieve your strategic and tactical objectives.
- [Eligibility & Billing](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/eligibility-billing/) - We offer eligibility and billing solutions to optimize healthcare operations, improve efficiency, and ensure accurate, compliant billing practices.
- [Accreditation Preparation & Review](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/accreditation-preparation-review/) - We provide expert accreditation preparation and review services, ensuring businesses meet industry standards and achieve successful accreditation outcomes.
- [Sitemap](https://www.attacconsulting.com/sitemap/) - Pages #9554 (no title) About ATTAC Consulting Group Aaron Eaton Sr., Vice President, Corporate Strategy & Product Development Our Approach ATTAC Consulting Group’s Leadership and Consulting Team Anne Crawford, Sr. Vice President, Compliance Solutions Anne Marie Youlio, Pharm.D., R.Ph.,C.Ph, Program Lead Dory Hicks, Director Jocelyn Bayliss, Program Lead, Provider Network Management Kirk Martindale, Vice President,
- [Mental Health Parity NQTL Analyses for Health Plans and ERISA Self-Funded Groups](https://www.attacconsulting.com/compliance/mental-health-parity-get-ready-for-dol-audit/) - ATTAC's Mental Health Parity specialists help you prepare NQTLs and reduce possible penalties. Learn how we can help with Mental Health Parity Compliance.
- [Claims Processing](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/claims-processing/) - ATTAC's consultants have a business-efficiency and technology-enablement focus paired with best practice recommendations to support your organization.
- [Medicaid Health Plans and MCOs](https://www.attacconsulting.com/about/health-plans/medicaid-plans/) - ATTAC Consulting provides targeted services to Medicaid plans and MCOs to address challenges of improving health outcomes, costs, operations, & regulations.
- [Government and Teaming Partners](https://www.attacconsulting.com/about/government-services/) - ATTAC has years of experience evaluating and auditing organizations operating state and federal health programs, including insurers, health, and drug plans.
- [IPAs, ACOs & Health Systems](https://www.attacconsulting.com/about/acos-health-systems-providers/) - ATTAC provides expert solutions for health systems & providers, focusing on improving operations, compliance, and care quality with tailored strategies.
- [Care Management Operations](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/care-management-operations/) - Effective operations include thorough analytics, assessment, and referral processes and more to proactively identify and meet the needs of plan members.
- [HHS RADV Insights: ATTAC's Top Added & Top Failed RADV HCCs by Volume](https://www.attacconsulting.com/hhs-radv-insights-attacs-top-added-top-failed-radv-hccs-by-volume/) - Read our Top Added & Top Failed RADV Hierarchical Condition Categories (HCC) insights PDF.
- [Business & Operations Transformation](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/business-operations-transformation/) - Our teams understand health plan operations. We bring knowledge of best practices that enhance the evolution of possible solutions and implications of changes.
- [Who We Help](https://www.attacconsulting.com/about/) - ACG’s team develops solutions that execute on details and deliver business results for Health Plans, PBMs, IPAs, ACOs, Providers, and Government Agencies.
- [Case Studies | Webinars](https://www.attacconsulting.com/case-studies-webinars/) - COMPLIANCE [Webinar Replay] 2025 Final Rule and New Mental Health Parity Rule: Regulatory Changes Providers and Plans Need to Know Webinar Replay | Navigating the Telephone Consumer Protection Act for Healthcare Organizations Webinar Replay | How Providers and Health Plans Can Collaborate to Maximize Revenue and Quality Webinar Replay | Mental Health Parity NQTL Assessment:
- [Training](https://www.attacconsulting.com/services-solutions/training/) - ACG has developed a series of programs to support plans and training needs and methods for monitoring internal and FDR/contractor/delegate operations.
- [ATTAC Consulting Group Privacy Policy](https://www.attacconsulting.com/attac-consulting-group-privacy-policy/) - For more information or questions regarding this privacy policy, please contact privacy@attacconsulting.com. 1. Personal Information Your privacy is very important to ATTAC Consulting Group (ACG). We have established this privacy policy to explain how your personal information is protected, collected, and used. Personal information is information about you that is personally identifiable, such as your
- [New Solution Identification, Vendor Selection & Management ](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/new-solution-identification-vendor-selection-management/) - When thinking about new and improved solutions, it’s important that healthcare organizations understand and quantify strategic objectives and perform marketplace assessments to identify the best available tools to achieve their goals. ATTAC assists healthcare organizations plan for and manage relationships with solution vendors. Whether vendors are providing specialized care programs, or contributing back-office technical and
- [Solution Implementations & Migrations](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/solution-implementations-migrations/) - Healthcare organizations are looking to maximize the value gained from investments in information technology solutions. Our teams draw upon industry best practices and their own experience across the continuum of the healthcare industry. This enables our clients to reach an optimized level of technology and business alignment. Our consultants collaborate with business staff, technical
- [Medicare & Part D](https://www.attacconsulting.com/services-solutions/plan-development-applications/medicare-part-d/) - ACG assists with Medicare Advantage and Part D Benefits, including operational and compliance requirements as well as subcontractor monitoring.
- [Health Plans](https://www.attacconsulting.com/about/health-plans/) - For more than a decade, ACG has been a go-to and trusted partner for leading national and regional health plans operating commercial and government programs.
- [Services & Solutions](https://www.attacconsulting.com/services-solutions/) - ATTAC offers expert support and solutions for health plan operations in Medicare, Medicaid, Health Exchange (HIX), Dual Demo, and Commercial programs.
- [Medi-Cal: The Duals Migration to D-SNP](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/medi-cal-the-duals-migration-to-d-snp/) - California Medi-Cal (CMC) plan models have long been innovative and tailored to specific regional differences. As a result of the recent CalAIM mission to offer integrated and full-scope benefits to dual-eligible individuals, the state took additional steps to ensure wraparound coverage to the dual-eligible population. The Medicaid transformation required plans to form D-SNPs, completely revamp
- [Newsletters](https://www.attacconsulting.com/newsletters/) - Publications/Newsletters August, 2023 July, 2023 June, 2023 May, 2023 April, 2023 March, 2023 February, 2023 January, 2023
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- [Thank You](https://www.attacconsulting.com/thank-you-submission/) - Thanks for contacting ATTAC Consulting Group! We will get in touch with you shortly.
- [FDR Oversight & Monitoring](https://www.attacconsulting.com/services-solutions/training/fdr-oversight-monitoring-and-auditing/) - ATTAC Consulting Group provides extensive resources and solutions to Plans to support management of delegate performance and compliance.
- [Government Agencies, Departments & Partners](https://www.attacconsulting.com/services-solutions/government-partners/) - ACG partners with federal agencies and state Departments of Insurance, Departments of Health, and Managed Care who oversee insurers and healthcare programs.
- [Plan Development & Applications](https://www.attacconsulting.com/services-solutions/plan-development-applications/) - ACG helps organizations launch new health plans; expand service areas; develop Medicare Advantage Plans, launch Health Exchange (HIX) products and more.
- [Technology Strategy Development ](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/technology-strategy-development/) - With technology evolving rapidly, organizations need to define and articulate short- and long-term strategies for technology enablement, growth and improvement. In order to craft a plan for your organization’s future, our experienced consultants will work with your executives to review the state of industry today and the direction healthcare is moving. Marketplace assessments Executive
- [Readiness & Operational Assessments & Remediation](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/readiness-assessments/) - ACG's mock CMS Program Audit applies CMS audit protocols and testing and is performed by Part C, Part D, SNP and Compliance experts in each audit domain.
- [Where is Your Plan In Its Health Equity Journey?](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/where-is-your-plan-in-its-health-equity-journey/) - Planning Just beginning: We’ve talked about making a plan, but we haven’t really started yet. Executing Have a plan & working on executing: We’ve developed a plan but haven’t executed yet — we’re working on how & when to implement. Assessing Assessing our current plan for improvement: We’ve recently implemented our plan & are monitoring
- [Customer Engagement](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/customer-engagement/) - Health plan customers aren’t just your members. They’re also your providers, employers, brokers and vendors. The key to engagement is to ensure that your customers have an ongoing positive experience, which will keep them aligned with your organization. ATTAC’s team of process experts can help your plan examine and improve interactions with your customers
- [Complaints, Appeals & Grievances](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/appeals-grievances/) - ACG provides expert guidance for compliant and effective management of Grievances and Appeals for Medicare Advantage, Part D, Medicaid and HIX programs
- [Solution Assessment & Optimization ](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/solution-assessment-optimization/) - Healthcare has historically lagged behind other industries in technical evolution. Recent changes have provided new and improved options for organizations to take advantage of state-of-the-art solutions to improve efficiency and accuracy, while ensuring compliance with regulatory requirements. ATTAC helps clients review current-state solutions to look for ways to improve performance, which may include optimizations, upgrades
- [Interim Staffing](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/interim-staffing/) - ACG provides experienced interim staff resources when you need to quickly expand capacity, fill a vacancy, or need subject-matter experts for the short-term.
- [Commercial Insurers & Marketplace Health Plans](https://www.attacconsulting.com/about/health-plans/qualified-health-plans/) - ATTAC Consulting Group - Support for Commercial Insurers and Marketplace health plans with business transformation, operations, risk adjustment and compliance.
- [State Licensure, Applications & Product Launch](https://www.attacconsulting.com/services-solutions/plan-development-applications/licensure-applications/) - ACG’s teams provide expertise in submitting licensure applications, completing product line applications or RFPs and service area expansions.
- [Provider Network Performance](https://www.attacconsulting.com/services-solutions/provider-networks-old/provider-network-performance/) - ACG's multi-dimensional team can assist payers and providers to develop, implement and maintain high quality cost-effective provider networks.
- [Regulatory Reporting & Medicare Data Validation Audits](https://www.attacconsulting.com/services-solutions/auditing/regulatory-reporting-data-validation/) - ACG provides audit support and expertise for regulatory reporting and data validation services for Medicare Advantage and Part D, Medicaid, and QHP issuers.
- [Medical and Clinical Pharmacy Support](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/medical-quality/) - ACG’s Medical and Clinical Pharmacy support addresses a wide range of services while ensuring quality and continuity of care for insurance and MCO's.
- [Appeals & Grievances](https://www.attacconsulting.com/services-solutions/training/appeals-grievances/) - ACG's Medicare Part C and Part D Grievance and Appeals Training Manual Series translates CMS regulations into practical guidance for Plans.
- [ATTAC Consulting Group Welcomes Aaron Eaton as Senior Vice President for Corporate Strategy and Product Development](https://www.attacconsulting.com/news/attac-consulting-group-welcomes-aaron-eaton-as-senior-vice-president-for-corporate-strategy-and-product-development/) - July 6, 2022 – ATTAC Consulting Group, a premier national consulting and auditing firm serving insurers, managed care and provider organizations operating government and commercial health care programs, announced that Aaron Eaton has joined the firm as Senior Vice President for Corporate Strategy and Product Development. In his new role with ATTAC, Mr. Eaton leads
- [Latest News](https://www.attacconsulting.com/latest-news/)
- [Merger & Acquisition Support](https://www.attacconsulting.com/services-solutions/merger-acquisition-support/) - ACG help buyers, sellers and investors with pre-deal diligence and post-deal integration to maximize deal value and address important issues.
- [Medicare Advantage and Part D Data Validation](https://www.attacconsulting.com/services-solutions/auditing/medicare-advantage-and-part-d-data-validation/) - ATTAC Consulting Group (ACG) is one of the nation’s leading CMS Part C and Part D Data Validation Auditors.
- [Audit & Oversight](https://www.attacconsulting.com/services-solutions/government-partners/audit-oversight/) - ACG’s team of professionals all have real-world, hands-on experience working with the diverse organizations that operate government health programs.
- [ATTAC as a Teaming Partner](https://www.attacconsulting.com/services-solutions/government-partners/acg-as-a-teaming-partner/) - ACG is the right-fit partner for government healthcare program contracts and task orders. ACG can help meet small business set-asides.
- [Project and Program Management](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/project-and-program-management/) - ATTAC Consulting Group helps clients implement large and small-scale projects. Our project managers have expertise in managing a wide variety of engagements. ATTAC’s project management team brings key tools, techniques and experience to drive projects forward to achieve targeted and timely completion. We can step in to support troubled projects by rapidly assessing current status,
- [Enrollment, Claims and Core Operations](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/core-operations-enrollment-claims-ops/) - ACG delivers expert guidance in developing efficient, predictable and compliant business process solutions for Medicare, Medicaid, HIX and commercial insurers.
- [Information Systems and Technology](https://www.attacconsulting.com/services-solutions/business-operations-technology-transformation/it-systems/) - ACG provides selection, implementation and integration and project management services for IT and systems engagements
- [Operations Auditing and Process Improvement](https://www.attacconsulting.com/services-solutions/auditing/operations-auditing/) - Through our team expertise across key domains, ACG assesses business processes for strengths and weaknesses that impact operational performance and profitably.
- [Enrollment](https://www.attacconsulting.com/services-solutions/training/enrollment/) - ACG provides training on the fundamentals and details of enrollment and reconciliation events to ensure efficient, accurate and compliant operations.
- [Jocelyn Bayliss, Program Lead, Provider Network Management](https://www.attacconsulting.com/about-acg/consulting-team/jocelyn-bayliss-program-lead/) - Jocelyn Bayliss is the Program Leader for ATTAC’s Provider Network Development and Management Team. She specializes in managing large-scale provider network contracting engagements, network development and management strategies, including network directory maintenance. Jocelyn guides clients in design of provider compensation models for Medicare, Medicaid and commercial programs including risk sharing, quality and Star incentive design.
- [Kirk Martindale, Vice President, Data Audit Group](https://www.attacconsulting.com/about-acg/consulting-team/kirk-martindale-program-manager/) - Kirk is a member of the Government Programs and Health Plan Operations groups.
- [Anne Crawford, Sr. Vice President, Compliance Solutions](https://www.attacconsulting.com/about-acg/consulting-team/anne-crawford-director/) - Anne leads ATTAC Consulting's Compliance and Audit teams, specializing in Government and Commercial Programs; Medicare, Part D, Medicaid, ACA, HIX & QHPs.
- [Mark Grossman, Sr. Advisor (Emeritus)](https://www.attacconsulting.com/about-acg/consulting-team/mark-grossman-principal/) - Mark is a principal, serving as Practice Director of ACG’s Mergers and Acquisition Practice Group and is a leader in ACG’s Health Exchange (HIX) Group.
- [Steve Arbaugh, Managing Principal and CEO](https://www.attacconsulting.com/about-acg/consulting-team/steve-arbaugh-ceo-and-managing-principal/) - Steve is ACG's is a founding member and CEO of ATTAC Consulting Group, a national leader in Medicare, Medicaid and ACA / HIX related health care programs
- [Strategy & Assessment](https://www.attacconsulting.com/services-solutions/plan-development-applications/strategy-assessment/) - ACG provides strategic guidance and feasibility support and conducts reviews for a broad range of critical strategy and product development needs.
- [Aaron Eaton Sr., Vice President, Corporate Strategy & Product Development](https://www.attacconsulting.com/about-acg/aaron-eaton-sr-vice-president-corporate-strategy-product-development/) - Aaron Eaton leads initiatives focused on solving business challenges faced by Medicare Advantage, Medicaid and Health Insurance Exchange issuers. As government healthcare programs adapt to a rapidly-changing environment, he and his colleagues at ATTAC provide guidance on how plans can maximize revenue opportunities, evaluate efficiency and effectiveness, and ensure compliance. He has held multiple healthcare
- [Anne Marie Youlio, Pharm.D., R.Ph.,C.Ph, Program Lead](https://www.attacconsulting.com/about-acg/consulting-team/anne-marie-youlio-program-lead/) - Anne Marie Youlio is the leader of ACG's clinical pharmacy practice and compliance auditing teams encompassing Medicare Part D, Medicaid and specialty drugs.
- [Dory Hicks, Director ](https://www.attacconsulting.com/about-acg/consulting-team/dory-hicks-director/) - Dory is a practice leader in ACG's Health Plan Operations and Information Systems and Data groups.
- [Terms & Privacy](https://www.attacconsulting.com/terms-privacy/) - ACG Terms & Privacy
- [Internal Monitoring & Auditing Programs](https://www.attacconsulting.com/services-solutions/auditing/internal-monitoring-auditing-programs/) - ACG’s compliance teams can guide you in effective compliance programs that build internal monitoring and auditing across the organization.

## Leadership Team

- [Elizabeth Nuñez](https://www.attacconsulting.com/leadership_team/elizabeth-nunez/) - Elizabeth Nuñez brings deep expertise in healthcare operations, client engagement, and project management, overseeing complex initiatives from strategy through execution to deliver measurable results. She guides clients in designing strong business processes and implementing the right controls, oversight, and monitoring to safeguard accuracy from data intake through submission.
- [Tammy Knapp](https://www.attacconsulting.com/leadership_team/tammy-knapp/) - Tammy Knapp is ATTAC Consulting Group’s Director of Administration. Tammy is responsible for managing the administrative staff, project opening and closing, guiding operating methods, monitoring budgets, improving information systems, overseeing human resources requirements, updating senior executives, analyzing financial data, and developing operating policies and procedures. In addition, Tammy is responsible for ATTAC’s Salesforce Instance for
- [Aaron Eaton](https://www.attacconsulting.com/leadership_team/aaron-eaton-sr/) - Aaron Eaton leads initiatives focused on solving business challenges faced by Medicare Advantage, Medicaid and Health Insurance Exchange issuers. As government healthcare programs adapt to a rapidly-changing environment, he and his colleagues at ATTAC provide guidance on how plans can maximize revenue opportunities, evaluate efficiency and effectiveness, and ensure compliance. He has held multiple healthcare
- [Regan Pennypacker](https://www.attacconsulting.com/leadership_team/regan-pennypacker/) - Regan Pennypacker is a distinguished leader in managed care and regulatory affairs, bringing over 25 years of experience to her role as Senior Vice President of Compliance Solutions at ATTAC Consulting Group. A recognized expert in driving operational excellence, Regan specializes in aligning complex regulatory integrity with overarching organizational goals across the healthcare landscape. Regan’s
- [Anne Marie Youlio](https://www.attacconsulting.com/leadership_team/anne-marie-youlio/) - Anne Marie bring clients over 25 years of experience as professional pharmacist in various positions within consulting organizations, pharmaceutical industry and retail pharmacy. She has background managing pharmacy operations in Medicare Part D and Medicaid markets with broad experience in CMS Medicare Program Audits, project management, Fraud Waste and Abuse, and staff training. She brings
- [Kirk Martindale](https://www.attacconsulting.com/leadership_team/kirk-martindale/) - Kirk Martindale is a member of ATTAC’s Government Programs and Health Plan Operations group and leads the HHS RADV audit group and various Medicare audit teams. He guides clients in operations development, specializing in business process design and improvement, engineering data management in enrollment and reporting areas, and compliance management for organizations serving the government
- [Anne Crawford](https://www.attacconsulting.com/leadership_team/anne-crawford/) - Anne Crawford serves as the practice leader for ATTAC’s government programs Regulatory, Compliance and Audit Group. With 25 years of leadership in the industry, she guides clients on licensure, regulatory management, corporate compliance and integrity programs, audit readiness and planning, public policy development, strategic planning, process improvement, product development, and product management. Prior to joining
- [Kevin Barbee](https://www.attacconsulting.com/leadership_team/kevin-barbee/) - Kevin Barbee is a healthcare executive who has served as a strategic advisor and thought leader. He has supported crucial business transformation initiatives and major programmatic and technology implementations for premier national insurers, health plans and provider organizations. Kevin’s leadership and 30 years of experience spans diverse engagements. He guided the development of the multi-year
- [Christine Carbonaro](https://www.attacconsulting.com/leadership_team/christine-carbonaro-cpc-cpc-p-cpma-crc-cpc-i/) - Christine Carbonaro is ATTAC Consulting Group’s Director of Medical Record Coding Operations, part of ATTAC’s Risk Adjustment and Data Audit groups. She is a risk adjustment expert with deep experience in CMS (MRA) and commercial (ACA) risk adjustment models, clinical documentation and coding requirements. For more than 18 years, Christine has led coding, auditing, and
- [Subbu Ramalingam](https://www.attacconsulting.com/leadership_team/subbu-ramalingam/) - Subbu Ramalingam leads ATTAC’s Risk Adjustment and Stars/Quality practice. Subbu has more than 20 years of experience driving growth, value, and results in healthcare, technology, and financial services. Throughout his career, Subbu has held leadership roles in national and regional payer organizations, as well as technology/consulting companies. Most recently, he was the Vice President of
- [Jennifer Eidam](https://www.attacconsulting.com/leadership_team/jennifer-eidam/) - Jennifer Eidam is a seasoned sales professional with extensive experience in healthcare, SaaS, and pharmaceutical industries. In her years of working with payers, she has demonstrated exceptional leadership and business development skills. In her role with ATTAC Consulting Group, Jennifer provides tailored, strategic guidance to clients, helping payers and providers optimize operations and achieve growth.
- [Jocelyn Bayliss](https://www.attacconsulting.com/leadership_team/jocelyn-bayliss/) - Jocelyn Bayliss is the senior vice president of ATTAC’s Provider Network Development and Management Team. She specializes in managing large-scale provider network contracting engagements, network development and management strategies, including network directory maintenance. Jocelyn guides clients in design of provider compensation models for Medicare, Medicaid and commercial programs, including risk sharing, quality and Star incentive
- [Steve Arbaugh](https://www.attacconsulting.com/leadership_team/steve-arbaugh/) - Steve Arbaugh is ATTAC Consulting Group’s managing principal and CEO, and has served as CEO and COO for various insurance and managed care organizations. Steve has stepped in as CEO for health plans during restructuring and turnaround situations to lead strategy, revitalization, operational improvement and compliance enhancement. Over 34 years, he has guided and led
- [Kenneth McNeal](https://www.attacconsulting.com/leadership_team/kenneth-mcneal/) - Kenneth McNeal, who serves as ATTAC’s SVP and Chief Revenue Officer, is responsible for managing key relationships with clients across the nation. He has extensive experience in delivering solutions to healthcare payers, with particular expertise in solutions supporting Medicare Advantage programs in areas including risk adjustment, Star Ratings and quality programs, and sales and broker

## Consultants

- [Courtney Overton](https://www.attacconsulting.com/consultants/courtney-overton/) - Courtney Overton is a seasoned healthcare compliance and regulatory expert with extensive experience in health plan operations, audit readiness, and accreditation standards. With more than a decade of expertise in quality assurance, reporting, and regulatory compliance, she specializes in ensuring health plans meet state and federal regulations including CMS, NCQA, and quality review organization requirements.
- [Lisa Hardisty](https://www.attacconsulting.com/consultants/lisa-hardisty/) - Lisa has more than 20 years of experience in commercial, Medicaid, and Medicare managed care operations and compliance, where she developed organizational solutions to ensure operational compliance while meeting internal and external stakeholder needs. She has developed and led multi-disciplinary teams spanning operations, compliance, and technology across a broad spectrum of managed care operations. Her
- [Tara Alderink](https://www.attacconsulting.com/consultants/tara-alderink/) - Tara Alderink is an accomplished project management professional with a track record of driving business growth, fostering client relationships, and delivering exceptional project execution. With experience in healthcare, pharmaceuticals, and logistics, she excels at problem-solving, strategic planning, and optimizing operational efficiency. At ATTAC, Tara forges strong partnerships with the firm’s RADV audit clients. Her commitment
- [Tammy Hall](https://www.attacconsulting.com/consultants/tammy-hall/) - Tammy Hall is a results-driven healthcare professional with extensive experience in health plan operations, specializing in compliance, risk management, and regulatory adherence. With a proven track record in leading comprehensive compliance programs, Tammy has successfully guided health plans through the complexities of CMS guidelines, state, and federal regulations. Throughout her career, Tammy has excelled in
- [Chhaya Surti, PharmD, MJ](https://www.attacconsulting.com/consultants/chhaya-surti-pharmd-mj/) - Chhaya Surti, PharmD, MJ, is a seasoned pharmacist consultant with extensive experience in health plan operations. In her role with ATTAC, Chhaya leverages her pharmaceutical expertise to provide strategic guidance, ensure compliance with regulatory standards, and optimize operational efficiency. Prior to ATTAC, she worked with Cigna and CVS Caremark in leadership roles to direct Part
- [Ashleigh Majdeski](https://www.attacconsulting.com/consultants/ashleigh-majdeski/) - With more than 30 years of success in healthcare environments, Ashleigh serves as the practice leader for ATTAC’s Provider Network Operations and Performance Team. She supports health plans operating Medicare, Medicaid, and commercial products, leading clients through merger and acquisition integrations, process assessments and improvements, and on-demand interim staffing placements. Ashleigh guides health plans and
- [Miriam Regalado](https://www.attacconsulting.com/consultants/miriam-regalado/) - Ms. Regalado has more than 25 years of healthcare experience with comprehensive knowledge of compliance regulations related to federal and various state Medicaid and commercial requirements. She has extensive experience in health plan operations, including claims management, claims auditing, system configuration, business process design, and workflow development. She excels at the ability to analyze processes
- [Nancy Mundy](https://www.attacconsulting.com/consultants/nancy-mundy/) - Nancy Mundy, RN, is a compliance expert with nearly 30 years of experience, with specialties in Medicaid and Medicare, and Commercial compliance and plan operations. As a compliance and privacy officer, she has served on multiple executive leadership teams. Her expertise includes compliance program design and implementation, risk assessment/management and audit plan creations, key indicator
- [Erin Miskell](https://www.attacconsulting.com/consultants/erin-miskell/) - Erin is an experienced and successful Medicare Advantage compliance professional with ten years of experience in the healthcare industry. Erin’s background includes leadership positions in Medicare sales compliance/agent oversight, compliance program effectiveness/administration, delegated entity oversight, and health plan operations. She is experienced with project management methodologies, managing project stakeholder responsibilities and expectations, and has led
- [Paul Lake](https://www.attacconsulting.com/consultants/paul-lake/) - Paul Lake is a healthcare program and project leader with more than 25 years of experience in the industry. He has directed digital transformation implementations and multiple solutions for health plans with Medicaid, Medicare and commercial core systems. He has also led provider-focused revenue cycle management solution implementations. Paul steered multiple Program Management Office (PMO)
- [Dory Hicks](https://www.attacconsulting.com/consultants/dory-hicks/) - Dory has nearly 40 years of experience in guiding information technology and health plan operations departments and projects for insurance, managed care and state departments including major operations and IT centers. She has guided implementation and restructuring projects for national and local insurance, managed-care organizations, and public healthcare delivery systems. Dory has held numerous chief
- [Linda Hagen](https://www.attacconsulting.com/consultants/linda-hagen/) - Linda brings more than 30 years of expertise to clients in the health insurance and managed care industries. She is a senior consultant with experience in systems, operations, management and implementations. She has assisted states and health plans in procurement, analysis, monitoring and independent verification and validation. Linda has expertise in business process mapping and
- [Alan Bratton](https://www.attacconsulting.com/consultants/alan-bratton/) - Alan is a senior project manager with more than 26 years of experience in project management for large-scale systems and operations implementations, and engagements with specialization in Medicaid MMIS system implementation and operations. He has nearly a decade of experience in Medicare health plan, start-up and operations. Alan advises and guides client engagements in IT,
- [Marcia Anderson, BSN, RN](https://www.attacconsulting.com/consultants/marcia-anderson/) - Marcia has more than 30 years of experience and leadership and management of clinical and quality programs for Medicaid and Medicare Advantage programs and commercial products. She has deep expertise in the design, implementation and oversight of delegated medical management program models, including development of provider incentive and monitoring programs focused on effective and compliant
- [Victoria Nadzam, MSN, RN](https://www.attacconsulting.com/consultants/victoria-nadzam-msn-rn/) - Victoria Nadzam, MSN, RN, is an accomplished healthcare professional with expertise in clinical operations management, process and performance improvement, and accreditation and regulatory compliance. She has a proven track record of driving compliance with NCQA standards and optimizing healthcare delivery across diverse sectors, including Medicare, commercial ACA, and Medicaid. With Victoria’s background in clinical excellence,
- [Tina Gallagher](https://www.attacconsulting.com/consultants/tina-gallagher/) - Tina is a provider network contracting leader with 25+ years’ experience building Medicare, Medicaid and Marketplace networks and applying value-based payment models. She has C-Suite expertise in managing all aspects of health plan operations, including P&L, policy, strategy, plan management, network development, regulatory and compliance. Prior to joining ATTAC, Tina held state plan president positions
- [Justin Murakami, JD, CHC](https://www.attacconsulting.com/consultants/justin-murakami-jd-chc/) - Justin Murakami, JD, CHC, is a highly accomplished healthcare compliance expert with more than 14 years of experience with Medicaid, Medicare, commercial health plans and provider organizations, specializing in California's complex regulatory landscape. He is known for his leadership in regulatory audits, compliance program development, and risk mitigation for large health plans. At ATTAC Consulting,
- [Dr. Michael Chapman, DO, MHCM, MS, FACOEP](https://www.attacconsulting.com/consultants/dr-michael-chapman-do-mhcm-ms-facoep/) - Dr. Michael Chapman, DO, MHCM, MS, FACOEP, is a Clinical Advisor at ATTAC Consulting Group. He is board-certified in emergency medicine, with more than a decade of clinical experience. Dr. Chapman has served as Medical Director for a health plan with more than a million members in commercial, Medicare Advantage and Medicaid products. In his work
- [Elizabeth Nunez](https://www.attacconsulting.com/consultants/elizabeth-nunez/) - Elizabeth serves as program director in ATTAC's Data Audit Group. She supports clients on consulting engagements related to Medicare Advantage and Part D enrollment, reconciliation and premium billing operations, where she provides guidance on business process design and process controls and oversight and monitoring. Prior to joining ATTAC, Elizabeth held roles including manager of enrollment
- [Helene Jo, RN, MPH](https://www.attacconsulting.com/consultants/helene-jo/) - Helene is a member of ATTAC’s Clinical Management and Compliance Teams. She supports clients with expertise in implementing clinical and quality operations for Medicaid, Medicare Advantage, dual programs, special needs plans and commercial health plans. She is a specialist in SNP Model of Care design and implementation, Medicare STARs, CAHPS, HOS and other Quality Programs
- [David P. Giles](https://www.attacconsulting.com/consultants/david-p-giles/) - David has more than 30 years of experience provider reimbursement, risk-based contracting and value-based payment models. He works with health plans, physician groups, IPAs, medical groups and hospitals. He has extensive experience in market and product development, healthcare reimbursement and financing, development, and management of large-scale provider networks. David has worked with commercial, Medicare, Medicaid,
- [Pooja Pahwa](https://www.attacconsulting.com/consultants/pooja-pahwa/) - Pooja has more than 15 years of experience driving business and information technology transformations to successfully advance healthcare and pharmaceutical industries. She has focused on establishing a culture of collaboration and transparency, managed implementations of complex, heavy cross-dependency ground-up systems, upgrades and enhancements, and held high-visibility positions. Pooja provides independent, expert and general program management
- [Katie Meier](https://www.attacconsulting.com/consultants/katie-meier/) - Katie serves as a senior audit lead within the Data Audit Group. She supports project management, day-to-day audit operations, and quality assurance activities for government-mandated risk adjustment and data validation audits. Prior to joining ATTAC Consulting Group, Katie served in senior project management and customer service roles for various organizations.
- [Rich Dalton](https://www.attacconsulting.com/consultants/rich-dalton/) - Rich is an expert in encounter submissions and risk adjustment efforts. He has managed encounter submission and risk adjustment analytics teams across Medicare Advantage, ACA and Medicaid programs, along with risk adjustment operations and RADV for the ACA Marketplace. He has designed, deployed, analyzed, and refined prospective and retrospective programs. Rich draws on his extensive
- [Sharon Clackum, PharmD](https://www.attacconsulting.com/consultants/sharon-clackum/) - Sharon is a member of ACG’s clinical pharmacy team supporting Medicare Part D, Medicaid, and pharmacy benefit management groups. Sharon has extensive experience in integrated clinical practice, formulary management, operational process reengineering and PBM oversight. She has designed and implemented utilization management programs for long-term care provider groups (Medicare Part A/ managed care) and has
- [Darlene Dulac](https://www.attacconsulting.com/consultants/darlene-dulac/) - Darlene is a member of ACG’s Government Programs Practice Group. She brings broad expertise in organizational development and compliance management in the Medicare and Medicaid arenas. For over a dozen years, she has held senior legal and compliance roles within the insurance and managed care industries, where she has led activities as diverse as health
- [Eric Fuller](https://www.attacconsulting.com/consultants/eric-fuller/) - Eric has more than 30 years of experience in leading ATTAC’s data analytics group. He is adept in design and development of application front-end and back-end solutions to support numerous business needs. Eric is an experienced data technician and architect of database systems to support analytics and production applications. He is deeply experienced in ACA
- [Cindy Hedges](https://www.attacconsulting.com/consultants/cindy-hedges/) - Cindy is a member of ACG’s Government Programs group. She leads clients in health plan operations and compliance monitoring activities, specializing in licensure and regulatory interface, enrollment, customer service, grievance, appeal, CTM complaint management, marketing, sales oversight, HIPAA, internal and downstream delegate oversight and training program development across all operational arenas. Cindy also specializes in
- [Mia Kulick](https://www.attacconsulting.com/consultants/mia-kulick/) - Mia has more than 16 years of experience in regulatory compliance management with a specialization in compliance in clinical activities and oversight of behavioral health and substance abuse services. She provides legal, regulatory and compliance in clinical services for commercial and Medicaid specialty in serious mental illness, comprehensive long-term care and children’s medical services. Mia
- [Jon Rogers](https://www.attacconsulting.com/consultants/jon-rogers/) - Jon is a seasoned executive guiding risk adjustment programs for Medicare Advantage, ACA /Marketplace and Medicaid programs. He brings expertise in development and implementation of effective prospective and retrospective risk adjustment initiatives, appropriately targeted to maximize ROI. He is deeply skilled at guiding and developing analytics to identify/suspect potential risk adjustment opportunities, as well as

## Tags

- [Medicare Part D](https://www.attacconsulting.com/tag/medicare-part-d/)
- [Medicare Part C](https://www.attacconsulting.com/tag/medicare-part-c/)
- [Medicare Advantage](https://www.attacconsulting.com/tag/medicare-advantage/)
- [Part D](https://www.attacconsulting.com/tag/part-d/)
- [CMS](https://www.attacconsulting.com/tag/cms/)
- [prior auth](https://www.attacconsulting.com/tag/prior-auth/)
- [health equity](https://www.attacconsulting.com/tag/health-equity/)
- [Star Ratings](https://www.attacconsulting.com/tag/star-ratings/)
- [VBID](https://www.attacconsulting.com/tag/vbid/)
- [Value-based Insurance Design](https://www.attacconsulting.com/tag/value-based-insurance-design/)
- [2023 Proposed Rule Changes](https://www.attacconsulting.com/tag/2023-proposed-rule-changes/)
- [Provider directories](https://www.attacconsulting.com/tag/provider-directories/)
- [Provider contracting](https://www.attacconsulting.com/tag/provider-contracting/)
- [behavioral health](https://www.attacconsulting.com/tag/behavioral-health/)
- [PDP](https://www.attacconsulting.com/tag/pdp/)
- [HHS RADV](https://www.attacconsulting.com/tag/hhs-radv/)
- [ACA](https://www.attacconsulting.com/tag/aca/)
- [CMS 2024 Proposed Rule Changes](https://www.attacconsulting.com/tag/cms-2024-proposed-rule-changes/)
- [Medicare Advantage risk adjustment](https://www.attacconsulting.com/tag/medicare-advantage-risk-adjustment/)
- [broker compliance](https://www.attacconsulting.com/tag/broker-compliance/)
- [ICD-10](https://www.attacconsulting.com/tag/icd-10/)
- [Social determinants of health](https://www.attacconsulting.com/tag/social-determinants-of-health/)
- [SDOH](https://www.attacconsulting.com/tag/sdoh/)
- [mental health parity](https://www.attacconsulting.com/tag/mental-health-parity/)
- [risk score](https://www.attacconsulting.com/tag/risk-score/)
- [risk adjustment](https://www.attacconsulting.com/tag/risk-adjustment/)
- [overpayments](https://www.attacconsulting.com/tag/overpayments/)
- [Medicare Advantage RADV](https://www.attacconsulting.com/tag/medicare-advantage-radv/)
- [RADV](https://www.attacconsulting.com/tag/radv/)
- [DOL](https://www.attacconsulting.com/tag/dol/)
- [compliance risk](https://www.attacconsulting.com/tag/compliance-risk/)
- [DSNP](https://www.attacconsulting.com/tag/dsnp/)
- [Compliance](https://www.attacconsulting.com/tag/compliance/)
- [Health risk assessment](https://www.attacconsulting.com/tag/health-risk-assessment/)
- [model of care](https://www.attacconsulting.com/tag/model-of-care/)
- [SNP](https://www.attacconsulting.com/tag/snp/)
- [FFS adjuster](https://www.attacconsulting.com/tag/ffs-adjuster/)
- [Medicare Medicaid](https://www.attacconsulting.com/tag/medicare-medicaid/)
- [DSNPS](https://www.attacconsulting.com/tag/dsnps/)
- [Integrated Denial Notice](https://www.attacconsulting.com/tag/integrated-denial-notice/)
- [Updated Notice of Denial of Medical Coverage](https://www.attacconsulting.com/tag/updated-notice-of-denial-of-medical-coverage/)
- [in-home assessment](https://www.attacconsulting.com/tag/in-home-assessment/)
- [Medicaid](https://www.attacconsulting.com/tag/medicaid/)
- [Medicaid redetermination](https://www.attacconsulting.com/tag/medicaid-redetermination/)
- [Service Area Expansion](https://www.attacconsulting.com/tag/service-area-expansion/)
- [Provider Network](https://www.attacconsulting.com/tag/provider-network/)
- [mock audit](https://www.attacconsulting.com/tag/mock-audit/)
- [program audit](https://www.attacconsulting.com/tag/program-audit/)
- [NQTL](https://www.attacconsulting.com/tag/nqtl/)
- [Mental Health Parity Audit](https://www.attacconsulting.com/tag/mental-health-parity-audit/)
- [OIG](https://www.attacconsulting.com/tag/oig/)
- [OIG audits](https://www.attacconsulting.com/tag/oig-audits/)
- [FFS](https://www.attacconsulting.com/tag/ffs/)
- [HCBS](https://www.attacconsulting.com/tag/hcbs/)
- [Medicare-Medicaid plans](https://www.attacconsulting.com/tag/medicare-medicaid-plans/)
- [MMP](https://www.attacconsulting.com/tag/mmp/)
- [Performance Measure Validation](https://www.attacconsulting.com/tag/performance-measure-validation/)
- [risk adjustment member engagement strategy](https://www.attacconsulting.com/tag/risk-adjustment-member-engagement-strategy/)
- [provider networks](https://www.attacconsulting.com/tag/provider-networks/)
- [network adequacy](https://www.attacconsulting.com/tag/network-adequacy/)
- [provider credentialing](https://www.attacconsulting.com/tag/provider-credentialing/)
- [risk score accuracy](https://www.attacconsulting.com/tag/risk-score-accuracy/)
- [retrieved charts](https://www.attacconsulting.com/tag/retrieved-charts/)
- [retrospective chart review](https://www.attacconsulting.com/tag/retrospective-chart-review/)
- [Medicaid bids](https://www.attacconsulting.com/tag/medicaid-bids/)
- [network contracting](https://www.attacconsulting.com/tag/network-contracting/)
- [Formulary Administration](https://www.attacconsulting.com/tag/formulary-administration/)
- [low-income subsidy](https://www.attacconsulting.com/tag/low-income-subsidy/)
- [inflation reduction act](https://www.attacconsulting.com/tag/inflation-reduction-act/)
- [Medicare](https://www.attacconsulting.com/tag/medicare/)
- [extra help subsidy](https://www.attacconsulting.com/tag/extra-help-subsidy/)
- [2024 low income subsidy changes](https://www.attacconsulting.com/tag/2024-low-income-subsidy-changes/)
- [health equity framework](https://www.attacconsulting.com/tag/health-equity-framework/)
- [healthcare compliance](https://www.attacconsulting.com/tag/healthcare-compliance/)
- [Medicare STARS](https://www.attacconsulting.com/tag/medicare-stars/)
- [Medicare Advantage compliance](https://www.attacconsulting.com/tag/medicare-advantage-compliance/)
- [case management](https://www.attacconsulting.com/tag/case-management/)
- [HEDIS](https://www.attacconsulting.com/tag/hedis/)
- [CAHPS](https://www.attacconsulting.com/tag/cahps/)
- [AEP](https://www.attacconsulting.com/tag/aep/)
- [annual enrollment period](https://www.attacconsulting.com/tag/annual-enrollment-period/)
- [health equity index](https://www.attacconsulting.com/tag/health-equity-index/)
- [Proposed rules](https://www.attacconsulting.com/tag/proposed-rules/)
- [quality measurement](https://www.attacconsulting.com/tag/quality-measurement/)
- [broker compensation](https://www.attacconsulting.com/tag/broker-compensation/)
- [2025 proposed rule](https://www.attacconsulting.com/tag/2025-proposed-rule/)
- [dual eligible](https://www.attacconsulting.com/tag/dual-eligible/)
- [Managed care organizations](https://www.attacconsulting.com/tag/managed-care-organizations/)
- [D-SNP](https://www.attacconsulting.com/tag/d-snp/)
- [Business Transformation](https://www.attacconsulting.com/tag/business-transformation/)
- [healthcare technology](https://www.attacconsulting.com/tag/healthcare-technology/)
- [Business Operations](https://www.attacconsulting.com/tag/business-operations/)
- [D-SNPs](https://www.attacconsulting.com/tag/d-snps/)
- [Cal MediConnect](https://www.attacconsulting.com/tag/cal-mediconnect/)
- [Medi-Cal program](https://www.attacconsulting.com/tag/medi-cal-program/)
- [IPAs](https://www.attacconsulting.com/tag/ipas/)
- [CalAim](https://www.attacconsulting.com/tag/calaim/)
- [HCCs](https://www.attacconsulting.com/tag/hccs/)
- [Commercial Health Plans](https://www.attacconsulting.com/tag/commercial-health-plans/)
- [health plans](https://www.attacconsulting.com/tag/health-plans/)
- [Compliance training](https://www.attacconsulting.com/tag/compliance-training/)
- [FDR](https://www.attacconsulting.com/tag/fdr/)
- [FWA](https://www.attacconsulting.com/tag/fwa/)
- [utilization management](https://www.attacconsulting.com/tag/utilization-management/)
- [final rule](https://www.attacconsulting.com/tag/final-rule/)
- [UM audits](https://www.attacconsulting.com/tag/um-audits/)
- [telehealth](https://www.attacconsulting.com/tag/telehealth/)
- [virtual health](https://www.attacconsulting.com/tag/virtual-health/)
- [telemedicine](https://www.attacconsulting.com/tag/telemedicine/)
- [2025 Final Rule](https://www.attacconsulting.com/tag/2025-final-rule/)
- [supplemental benefits](https://www.attacconsulting.com/tag/supplemental-benefits/)
- [data accuracy](https://www.attacconsulting.com/tag/data-accuracy/)
- [data integrity](https://www.attacconsulting.com/tag/data-integrity/)
- [managed care org](https://www.attacconsulting.com/tag/managed-care-org/)
- [In-Home Health Assessment](https://www.attacconsulting.com/tag/in-home-health-assessment/)
- [member engagement](https://www.attacconsulting.com/tag/member-engagement/)
- [managed care orgs](https://www.attacconsulting.com/tag/managed-care-orgs/)
- [TCPA](https://www.attacconsulting.com/tag/tcpa/)
- [Next Veteran Affairs Community Care Network](https://www.attacconsulting.com/tag/next-veteran-affairs-community-care-network/)
- [VA CCN](https://www.attacconsulting.com/tag/va-ccn/)
- [network build](https://www.attacconsulting.com/tag/network-build/)
- [In-Office Assessments](https://www.attacconsulting.com/tag/in-office-assessments/)
- [coding accuracy](https://www.attacconsulting.com/tag/coding-accuracy/)
- [telephone consumer protection act](https://www.attacconsulting.com/tag/telephone-consumer-protection-act/)
- [access to care](https://www.attacconsulting.com/tag/access-to-care/)
- [provider availability](https://www.attacconsulting.com/tag/provider-availability/)
- [CHIP](https://www.attacconsulting.com/tag/chip/)
- [access survey](https://www.attacconsulting.com/tag/access-survey/)
- [availability survey](https://www.attacconsulting.com/tag/availability-survey/)
- [risk adjustment OIG](https://www.attacconsulting.com/tag/risk-adjustment-oig/)
- [V24](https://www.attacconsulting.com/tag/v24/)
- [V28](https://www.attacconsulting.com/tag/v28/)
- [risk adjustment best practices](https://www.attacconsulting.com/tag/risk-adjustment-best-practices/)
- [Grievances](https://www.attacconsulting.com/tag/grievances/)
- [Appeals](https://www.attacconsulting.com/tag/appeals/)
- [AI](https://www.attacconsulting.com/tag/ai/)
- [provider directory accuracy](https://www.attacconsulting.com/tag/provider-directory-accuracy/)
- [plan year 2026](https://www.attacconsulting.com/tag/plan-year-2026/)
- [open enrollment](https://www.attacconsulting.com/tag/open-enrollment/)
- [GLP-1](https://www.attacconsulting.com/tag/glp-1/)
- [anti-obesity medications](https://www.attacconsulting.com/tag/anti-obesity-medications/)
- [CY 2025](https://www.attacconsulting.com/tag/cy-2025/)
- [EOCs](https://www.attacconsulting.com/tag/eocs/)
- [secret shopper surveys](https://www.attacconsulting.com/tag/secret-shopper-surveys/)
- [provider network access and availability](https://www.attacconsulting.com/tag/provider-network-access-and-availability/)
- [QHP](https://www.attacconsulting.com/tag/qhp/)
- [IVA](https://www.attacconsulting.com/tag/iva/)
- [HPMS](https://www.attacconsulting.com/tag/hpms/)
- [healthcare system](https://www.attacconsulting.com/tag/healthcare-system/)
- [2026 Final Rule](https://www.attacconsulting.com/tag/2026-final-rule/)
- [provider access and availability](https://www.attacconsulting.com/tag/provider-access-and-availability/)
- [secret shopper](https://www.attacconsulting.com/tag/secret-shopper/)
- [Initial Determinations and Appeals](https://www.attacconsulting.com/tag/initial-determinations-and-appeals/)
- [ODAG](https://www.attacconsulting.com/tag/odag/)
- [Part C](https://www.attacconsulting.com/tag/part-c/)
- [quality](https://www.attacconsulting.com/tag/quality/)
- [population health](https://www.attacconsulting.com/tag/population-health/)
- [No Upcode Act](https://www.attacconsulting.com/tag/no-upcode-act/)
- [medical coding](https://www.attacconsulting.com/tag/medical-coding/)
- [Provider Network Management](https://www.attacconsulting.com/tag/provider-network-management/)
- [Health Plan Operations](https://www.attacconsulting.com/tag/health-plan-operations/)
- [MA RADV](https://www.attacconsulting.com/tag/ma-radv/)
- [Coding](https://www.attacconsulting.com/tag/coding/)
- [Validira](https://www.attacconsulting.com/tag/validira/)
- [CY2027](https://www.attacconsulting.com/tag/cy2027/)
- [Rate Announcement](https://www.attacconsulting.com/tag/rate-announcement/)
- [Stars Ratings](https://www.attacconsulting.com/tag/stars-ratings/)
- [Health Plan Strategy](https://www.attacconsulting.com/tag/health-plan-strategy/)
- [CY2027 Final Rule](https://www.attacconsulting.com/tag/cy2027-final-rule/)