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Operations

BluePeak Advisors can provide health plans and pharmacy benefit managers assistance with Part C and D Medicare operations remediation and efficiencies.

Compliance

BluePeak will prepare health plans and PBMs for CMS Program 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.

Strategy

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.

Gain KnowlEDGE with Our New Training Curriculum

BluePeak is pleased to offer online and instructor-led training, anytime, anywhere. Our training covers a wide range of government health related topics and can be delivered online, in person or via webinar. Our training focuses on audit readiness and operational excellence for Medicare and Medicaid plans.

Solutions

We offer comprehensive call log reviews, Centers for Medicare and Medicaid Services (CMS) guidance updates, member material reviews, Part D rejected claims reviews, universe monitoring, CMS Independent Validation Audits and support, Part C claims processing audits, fraud, waste and abuse (FWA) action plans, and prescription drug event (PDE) management.

Medicare Sales & Marketing

BluePeak’s comprehensive Medicare Annual Enrollment Period (AEP) Support from pre-AEP, during and post AEP including:

  • Sales & Marketing Oversight Assessments
  • Bid – PBP Quality Reviews
  • Member Material Development and/or Review
  • Broker Assessments
  • Sales Training Development Support
  • AEP Agent Secret Shopping Reviews

Ways We Can Help

BluePeak offer comprehensive consultant services, ranging in scope from limited-duration, customized projects to full interim staff support. BluePeak offers tools, trainings, assessments, and audits for your health insurance needs in Medicare, Medicaid, Commercial and self-funded arenas.

Solutions by Market

BluePeak is a leading national healthcare consultancy that focuses on government programs including Medicare Parts C and D, Medicaid, and Exchanges. We assist health plans, pharmacy benefit management (PBM) companies allied health companies and pharmaceutical manufacturers with regulatory, operational and compliance issues. BluePeak can analyze an organization’s processes and provide practical solutions, operational best practices and training to meet Medicare and other government program standards in all key areas.

Connect with us

Health Plans

The largest segment of our business is focused on health plans and assisting you with compliance, operations and interim staffing solutions. We are a leading Independent Validation Audit (IVA) vendor and have conducted over 150 mock Centers for Medicare and Medicaid Services (CMS) program audits and onsite support projects for clients undergoing actual CMS program audits.

Pharmacy Benefit Management

A large segment of our business is focused on pharmacy benefit management (PBM) companies and assisting you with compliance, operations and interim staffing solutions. We have extensive experience in the PBM world, both on the clinical and operational side, with many operations experts and both founders of BluePeak being from the PBM industry.

Pharmaceutical Manufacturers

BluePeak’s value to pharma stems from our extensive knowledge of the health plan, PBM and employer client marketplaces since we deal with them daily. We have in-depth experience with CMS policy and operational issues, and experience with many of the current PDPs and MAPDs.

Allied Healthcare Companies

BluePeak supports allied health companies in their efforts to provide compliant and effective products and services to health plans and Pharmacy Benefit Managers (PBMs). Applying insight gained from working with these industries, we provide clinical and regulatory subject matter expertise.

Medicaid

BluePeak is familiar with the nuances between states and their administration of the Medicaid program. We are able to provide many of our Medicare services, such as mock audit and audit support, marketing material review, operational assessments, and others, to our Medicaid clients.

Formulary Development and Support

BluePeak understands the importance of formulary management in driving clinical and financial outcomes. Our multi-disciplinary team can design and manage formulary solutions that align with your organization’s unique goals.

“BluePeak asked all the right questions to help us effectively prepare for our CMS Program Audit tracer review sessions.  In fact, after BluePeak’s pivotal guidance on how to strengthen our tracer summaries and how to think through the way in which to best answer the tough questions we might be asked by CMS, we ultimately had no findings during the CPE portion of our CMS Program Audit (even on the tracer summary we were most concerned about).  BluePeak’s CMS Program Audit support prep was invaluable to helping us thoroughly prepare, present with confidence, and drive our positive outcome.”

Medicare Compliance Officer, Fortune 50 Company

News & Insights

Stay connected with BluePeak Advisors to keep up-to-date on what is happening in the industry.

CMSNovember 2022Part D
November 21, 2022

Minimizing Hospice Billing Concerns

What is the Issue?1 In August 2019, the Department of Health and Human Services Office of Inspector General (OIG) released a report entitled, Medicare Part D is Still Paying Millions…
CMSMAMCMGMedicareNovember 2022
November 21, 2022

Risks in Misclassifying First Tier, Downstream, and Related Entities (FDRs)

There are a number of criteria outlining the oversight of First Tier, Downstream and Related Entities for Medicare Advantage Organizations.  Chapters 21 / 9 and 11 of the Medicare Managed…
MANovember 2022
November 21, 2022

Effective Strategies in Claims Quality Auditing

In light of ever rising benefit costs, employers and Medicare Advantage (MA) plans should consider regular claims quality auditing as part of an overall benefits and cost-containment strategy. Claims audits…