BluePeak Advisors can provide health plans and pharmacy benefit managers assistance with Part C and D Medicare operations remediation and efficiencies. We can analyze your processes and provide practical solutions and operational best practices to meet Medicare standards in all areas including coverage determinations, organizational determinations, appeals, grievances, formulary, call center, medication therapy management, claims, vendor management, provider contracting, SNP Model of Care, utilization management, enrollment, finance, marketing and sales. We can analyze workloads and develop staffing plans to meet your specific organizational needs, and provide interim staffing to fill a subject matter or management gap. BluePeak can also provide all required staff training to meet CMS requirements or refresh your staff on current operational and compliance policies and procedures.


BluePeak will prepare health plans and PBMs for CMS audits by performing mock CMS audits utilizing CMS protocols, reviewing operational area universes for compliance, supporting your teams during the actual CMS audits, assisting with writing corrective action plans and providing validation audits before CMS returns. We will coach and teach plans how to perform their own mock audits and how to review cases with CMS during actual audits. BluePeak can review and rewrite policies and procedures across all operational areas. We understand both the compliance and operations for Parts C and D from a business perspective giving BluePeak the practical advantage of assuring plan/PBM compliance while operating efficiently. BluePeak also provides healthcare policy and HPMS memo review and interpretation for your organization and translates guidance into practical business solutions. We have worked with several plans to help relieve them of their sanctions with CMS.


Medicare, the Exchanges and other government programs are evolving on a daily basis. BluePeak can provide health plans, Employer Group Waiver Plans (EGWPs) and PBMs strategic direction for product development and expansion both from a business growth perspective as well as from an internal support need. Pharmaceutical manufacturers and other allied health product companies will benefit from specific market segment knowledge, experience and direction in order to expand their business, build new products and succeed in the ever changing health care market.