Navigating the Complexities and Opportunities of the Medicare Prescription Payment Plan for Health Plans
The Centers for Medicare & Medicaid Services (CMS) introduced the Medicare Prescription Payment Plan (M3P) as a part of the Inflation Reduction […]
Ensuring a Successful Open Enrollment: Key Areas for Healthcare Payers & TPAs
As healthcare payers and third-party administrators (TPAs) gear up for the open enrollment period (OEP) and annual enrollment period (AEP), ensuring a […]
The Impact of Non-Compliance for Healthcare Organizations
In the intricate realm of healthcare, healthcare organizations confront the daunting challenge of adhering to stringent regulations. Non-compliance can precipitate severe financial […]
Critical Prep Areas for 2024 Utilization Management (UM)-Focused Audits
The 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) introduced new constraints on Utilization Management (UM) policies, particularly prior authorization, effective […]
FHIR® in Action: Streamlining Prior Authorization
Traditionally, prior authorization has been a complex, time-consuming process fraught with inefficiencies. Disconnected systems and manual procedures not only slow down care […]