As we move through 2024, fraud, waste, and abuse (FWA) continue to be significant issues within…
Category: News
Webinar: Decoding the HEDIS MY 2025 Technical Specifications
Three new measures, modifications to several existing measures, and various measure and indicator retirements are among…
Podcast: Star Ratings strategies for smaller MA plans
With the Centers for Medicare & Medicaid Services (CMS) recently deciding to recalculate the 2024 Star…
eBook: The three pillars of coordination of benefits (COB) success
As health plans grapple with rising expenses and heightened post-pandemic demand, a robust coordination of benefits…
Webinar: Engaging with members at the end of the year
As we approach the final quarter of 2024, both health plans and their members have many…
4 attributes of a successful specialty drug payment integrity program
Specialty drug claims are notoriously expensive and complex, comprising an estimated $243 billion of U.S. pharmaceutical…
eBook: How AI can drive health plan success
Payment integrity is an integral part of healthcare delivery, maximizing the value patients receive for their…
Recovering improper costs in SNF and IRF claims
Claims related to long-term care are complex. Members who require long-term care typically face a variety…
Webinar: Lessons learned from a successful prepay FWA program
As health plans increasingly adopt formal prepay fraud, waste, and abuse (FWA) programs, many still face…
Decoding the HEDIS MY 2025 Technical Specifications
After holding a public comment period earlier this year, the National Committee for Quality Assurance (NCQA)…