Health Plans

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Mock CMS Audits for Medicare Advantage, Prescription Drug Plans, EGWPs, PACE, QHP, Medicaid

One of the most important activities you can perform to get ready for CMS audits is practice universe pulls and mock CMS audits. BluePeak can assist with preparation of universes, training of staff to present during audits, and provide subject matter expertise in each CMS audit area. We employ former CMS auditors so we can execute a mock audit just as CMS will perform the audit, giving you actionable tasks to remediate before CMS identifies the issues.

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Universe Reviews

Every plan should be monitoring their universe data on a regular basis. BluePeak developed our Universe Monitoring Service, an audit-readiness resource that reviews universes for technical issues, analyzes and identifies risk and outliers, and coaches your team and FDRs on presenting the data.

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Compliance Program Implementation

BluePeak’s Compliance experts can build and help you implement a Compliance Program customized to your organization that meets CMS and other regulatory requirements. We will evaluate your organization’s structure and design and implement a comprehensive and effective Medicare Compliance Program with oversight plans, issue resolution, and corrective action plan processes.

Medicare Bid Development and PBP Review

It’s important that the Plan Benefit Package (PBP) you submit accurately reflects the intended benefit design described and supported by the bid pricing tool. BluePeak has experienced reviewers who have a strong understanding of the bid data entry process and can review the PBP for accuracy, implementation, and compliance.

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STAR Rating Projection and Gap Analysis

BluePeak can help you prioritize your resources to get the largest improvements for your dollar, as well as assist with project planning and strategies to enhance your Star ratings across all of your Part D measures. We can share best practices across the 4 and 5 Star plans that make them successful.

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Medicare Marketing Material Review

BluePeak has a team of experts trained and experienced in developing member materials and reviewing materials for common and uncommon errors. BluePeak incorporates best practices in every step of the process including comparing materials to the PBP and all current regulatory references. Our materials support process includes work on over 300 member material documents annually.

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