Single Member Experience Platform

Leaders of healthcare organizations who must adhere to Medicare or Medicaid regulations face an important decision: manage member issues in a single Member Experience Platform or buy several separate case tracking systems and seamlessly integrate them. The choice seems obvious. … Read More

Healthcare Compliance Monitoring and Process Improvements Made Easy

Pressure on member-facing staff at the beginning of a new year January and February are usually busy months for Medicare Advantage Organizations (MAO). New enrollees are still learning to navigate around the health plan to access medical services. Some are … Read More

CMS 2022 Audit Protocols for A&G

CMS 2022 Protocols for MMP SARAG & MMP CDAG Universe Submission

It is that time again! CMS Program Audits are imminent and the protocols have officially changed for 2022. This blog is to inform California MMP Plans of the changes to the CMS 2022 protocols for MMP SARAG & MMP CDAG Universes … Read More

Reach for the Stars

As a Medicare Advantage health plan, one of the main objectives should be to improve CMS Star Ratings. Why? Because the higher the ratings, the larger the bonus payments health plans receive from the government. This incentive exists to motivate … Read More

How to Master CMS Audit Preparation

CMS Audit preparation aren’t something you can cram for at the last minute and expect good outcomes. If health plans aren’t continuously monitoring all CMS universes for compliance issues, not only can errors creep into regulatory compliance tables, it highlights … Read More

How to Increase Your Health Plan’s CMS Star Ratings to Earn More Revenue In 2021

The CMS star ratings challenge Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Launched in 2007, star ratings enable the CMS as well as … Read More