Strengthening Cyber Resilience: Inovaare’s HITRUST r2 Certification Fortifies Healthcare Data Security

The recent cyberattack on a major healthcare IT vendor, as outlined in the letter from the U.S. Department of Health and Human Services, serves as a sobering reminder of the vulnerabilities facing the healthcare industry. With patient data and provider … Read More


Changes for Prescription Drug Encounter Data in 2024

The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. PDE provide the foundation for revenue reconciliation with drug plan … Read More

Pard B and Part D drugs payment

Proper Payments for Part B and Part D Drugs

Until the enactment of the Medicare Modernization Act (MMA) in 2006[1], the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home … Read More


Medicare Part D Risk Adjustments and Bidding Instructions for 2025

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. For the prescription drug program or Part D, the prescription drug hierarchical … Read More

cms-part c and part d

Navigating the 2025 Advance Notice: Implications for Medicare Advantage and Part D

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part … Read More

HCSC acquires Cigna

HCSC Acquires Cigna’s Medicare Businesses and CareAllies

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 billion. This strategic move is set to enhance HCSC’s capabilities and extend its … Read More