Grievance Management

Properly Classify Grievances to Improve Member Experience using Inovaare’s Grievance Management Software

Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance. This … Read More

FDR Oversight – Turning Policy & Procedure into Practice

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to … Read More

member-experience

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

compliance-process

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

cms-star

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