Compliance Isn’t Just Compliance Anymore: Three Ways Medicare Advantage Teams Can Shift From Retrospective Oversight & Deliver Strategic Value 

Charles Baker, VP, Compliance Solutions Compliance belongs at the strategic decision-making table to ensure the seamless integration of regulatory guidelines into the fabric of effective programs. For years, compliance in the health insurance sector, especially regarding government programs, has been synonymous with regulatory oversight. Compliance departments have

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Charles Baker Joins ATTAC Consulting Group as Vice President of Compliance Solutions

Baker is a distinguished leader in the healthcare industry, known for strategic expertise in health plan compliance and operational excellence ATTAC Consulting Group, a national leader in providing consulting, auditing, business operations and technology solutions to Medicare Advantage, Medicaid, commercial health insurers, and risk-bearing provider organizations, announced

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Changes To Level 1 Appeals for Medicare Advantage Plans: Appeal and Grievance Data Form Must Be Updated by Oct. 3, 2023 

Medicare Advantage (MA) plans must disclose grievances and appeals information to any MA plan-eligible individual upon request, including the number of disputes and outcomes.* It’s important to note that any MA plan-eligible individual may request this data, regardless of enrollment status. This allows individuals to evaluate and compare

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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

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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

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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

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