Claims related to long-term care are complex. Members who require long-term care typically face a variety…
Category: News
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)…
Partnering for success in 3 critical areas of risk adjustment
Health plans that participate in risk adjustment understand the importance of accurate and timely data on…
Webinar: Decoding the 2025 Star Ratings
Every October, the Centers for Medicare & Medicaid Services (CMS) publishes the annual Star Ratings for…
Webinar: Key updates to improve coding accuracy in 2025
Improving coding accuracy is a key priority for risk adjustment leaders to drive value for their…
Proactive member engagement strategies to close gaps in Medicare Advantage
With the Medicare Advantage Annual Election Period (AEP) underway, running now through December 7, health plans…
Webinar: What TPAs need to know about payment integrity
The self-insurance industry is witnessing a growing demand for effective payment integrity measures, driven by rising…
3 takeaways for Medicare Advantage plans from the 2025 Star Ratings
Despite no major methodological changes being made this year, overall performance in the 2025 Medicare Advantage…
Case study: Engaging members to apply for the Low-Income Subsidy (LIS)
As Medicare Advantage (MA) plans prepare for the introduction of the Health Equity Index (HEI) in…