What CMS Sees in Your CTM Data Before You Do
Every complaint that reaches the CMS Complaints Tracking Module is logged, categorized, and on the clock before your plan hears
Regulatory Compliance
Keeping Up With Regulatory Change Across States Without a War Room
The challenge is not adherence; most plans respond. It is whether the response is documented with a defensible evidence trail,
Medicare Advantage compliance is becoming operational surveillance
OIG’s Medicare Advantage compliance guidance points to a shift from process verification to operational surveillance. Health plans are increasingly expected to monitor trends continuously, detect behavioral patterns across denials, appeals, delegated oversight, and data quality, and demonstrate awareness of emerging risk before it becomes an audit issue.
The Cost of Compliance Variability in Healthcare Payer Operations
Compliance failures rarely begin with misconduct. They begin with variability. In healthcare payer operations, compliance risk rarely shows up as
Why Data Scrubbing Is the Missing Layer in Delegation Audit Defensibility
Why delegation audit defensibility is now a leadership issue Delegation audit defensibility used to be a compliance team concern. Today,
2026 CMS Program Audit Update: What Plans Must Do To Align
What Changed for 2026: Key Updates from CMS The 2026 audit update from CMS brings a fundamental shift in audit
CMS Policy Brief on AI for Payers
CMS Sets New Guardrails for AI in Medicare Advantage The New Regulatory Landscape: CMS Guidance on AI and Algorithms While
The CMS 2026 Program Audit Update: What I’m really hearing as a Chief Compliance Officer
When the 2026 Program Audit update landed, I didn’t read it as a checklist of changes. I’ve worked in healthcare
2026 CMS Program Audit Countdown: How Health Plans Can Prepare Now
The audit clock has already started CMS Program Audits follow predictable patterns, but most health plans still treat them as
How Disaster Declarations and Emergency Waivers Impact Health Plans
How automation protects compliance, revenue, and member trust For health plans, disasters don’t just test emergency response; they test compliance,
Why CMS and OIG Are Zeroing In on Conflict of Interest
What health plans must prove during audits Conflict of interest compliance is now a front-line issue for health plans. Regulators
TPA Compliance Risks for Health Plans: Is Your Third-Party Administrator/Vendor Putting You at Risk?
In the complex healthcare landscape, delegating critical functions to third-party administrators (TPAs) can streamline operations but also introduce significant compliance risks. With CMS intensifying oversight, health plans must recognize that accountability for every delegated action lies squarely with them. From data integrity gaps to missed SLAs, the hidden risks can lead to audit findings and financial penalties. Discover how a continuous, digital-first Delegation Oversight approach can transform your TPA management, ensuring compliance and protecting your members. Don’t let your vendors define your risk profile, take control and gain confidence in your oversight strategies.