Since its inception, BluePeak has been committed to making the complicated world of government-sponsored healthcare programs easier to navigate. BluePeak employees pride themselves on delivering outstanding consulting services to our varied clients through our motto of Knowledge, Experience, and Trust. Read through our past articles from our quarterly newsletters, news alerts, ad hoc insight articles, and Case Studies.
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The Compliance Program Effectiveness Test: Lessons from a Recent OIG Medicare Advantage Audit for RADV Readiness, Governance, and Enterprise Risk
A recent OIG audit found that a Medicare Advantage organization had many compliance controls in place, but they weren't aimed at its highest-risk diagnoses. Here's what that means for RADV…
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Enrollment Capacity Limits Are Here. The Bigger Question Is Whether Plans Are Ready.
Starting in Contract Year 2027, Medicare Advantage plans can ask CMS to cap enrollment. That sounds simple, but it brings real operational risk, both for plans that set a cap…
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BluePeak Solutions Spotlight Recap: Year-End Benefit Testing
A recap of BluePeak's August Spotlight on year-end benefit testing: what the 2027 Medicare Advantage and Part D changes mean for health plans, where testing usually uncovers problems, and a…
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Another Implementation: CMS Final Rule, Administrative Simplification and Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures
Learn how CMS's final rule on health care claims attachments and electronic signatures impacts health plans and providers, including X12 and HL7 standards, compliance requirements, and the May 2028 implementation…
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BluePeak News Alerts
- February 23, 2026Preparing for the Future of PACE Audits: Are You Ready for 2026?
- February 18, 2026HRSA’s latest Request for Information (RFI) offers a significant opportunity for stakeholders to help inform the development of a 340B Rebate Model Pilot Program.
- January 29, 2026CMS Releases Advance Notice: Flat MA Payments, Tighter Star Measures, and Greater Emphasis on Outcomes — Here’s What It Means for Plans
- January 6, 2026Intense Grievance Monitoring
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Read our previous insights.
Medicare Part D Redesign: Navigating the Changes in 2025
The Inflation Reduction Act (IRA) is poised to bring a significant transformation to the Medicare Part D benefit starting in 2025. This redesign will impact many stakeholders, including Part D…
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Understanding Non-Quantitative Treatment Limitations (NQTLs) and How BluePeak Advisors Can Help
In the evolving landscape of healthcare coverage, ensuring parity between mental health/substance use disorder (MH/SUD) and medical/surgical (Med/Surg) services is crucial. The Mental Health Parity and Addiction Equity Act (MHPAEA)…
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Important: Opportunity for PACE Organizations to Comment on CMS Proposed Updates
CMS has announced a 30-day comment period for the proposed collection entitled “The PACE Organization (PO) Monitoring and Audit Process” (CMS-10630; OMB control number: 0938–1327). This notice was published on…
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2025 Audit Insights: Elevating Call Center Performance with FCR and QOC Grievance Management
Member service representatives are the heart of a health plan. Their engagement with members significantly influences a member's perceived experience with the plan and their care journey. For a Medicare…
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The Model of Care Overhaul You Can’t Afford to Delay: Why 2025 Demands a Mock Audit Mindset
If your Model of Care (MOC) was written before 2025, it’s already outdated. With the release of the Centers for Medicare and Medicaid Services’ (CMS) draft MOC model documents, the…
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Navigating CMS Audits: Strategic Preparation for 2026
As you may have heard, the CMS Program Audit season has been slower this year due to contracting award issues affecting the pace. Despite this temporary slowdown, CMS's commitment to…
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Mock Audits – Stress-Test Before CMS Does
Member service representatives are the heart of a health plan. Their engagement with members significantly influences a member's perceived experience with the plan and their care journey. For a Medicare…
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Knowledge. Experience. Trust.
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