BluePeak Advisors, Author at BluePeak Advisors

CMPs CMS IRA Medicare NABA NONC Part D Spring 2024

The Importance of Medicare Marketing Material Development and Review, New changes coming and 2024 finding examples

Member materials are an important part of the Medicare member experience with a plan. Each year as Plan Sponsors finalize their product bid filing, CMS releases the upcoming plan year…

BluePeak AdvisorsMarch 29, 2024

CMS December 2023

The Centers for Medicare & Medicaid Services: 2024 Readiness Checklist for Medicare Advantage Organizations, Prescription Drug Plans

The Centers for Medicare & Medicaid Services (CMS) released the CY2024 Medicare Parts C and D Readiness Checklist on October 13, 2023. Although this is a busy time of year,…

BluePeak AdvisorsDecember 11, 2023

CMS December 2023 HHS SSBCI

Special Supplemental Benefits for the Chronically Ill: 2025 Proposed Rule Impacts to Consider

Believe it or not, it is already time to start thinking about plan benefits for contract year 2025. Plan sponsors continue to look for ways to grow membership, modify benefit…

BluePeak AdvisorsDecember 11, 2023

December 2023 Opioids Part D

Is Your Part D Stars Program Ready to Ring in the New Year?

On April 12, 2023, Centers for Medicare & Medicaid Services (CMS) published the 2024 Final Rule that postponed moving the three polypharmacy measures (Concurrent Use of Opioids and Benzodiazepines, Polypharmacy…

BluePeak AdvisorsDecember 11, 2023

CMS December 2023 IRA

Inflation Reduction Act (IRA): 2024 Summary of Changes and Oversight Considerations

The Centers for Medicare & Medicaid Services (CMS) has released significant guidance to support the Inflation Reduction Act (IRA) provisions that impacts Medicare enrollees, health plans, pharmacy benefit managers (PBM)…

BluePeak AdvisorsDecember 11, 2023

CMS December 2023 Utilization Management

2024 Final Rule Changes: Impacts on Utilization Management Tools and Proposed Changes for 2025.

The Final Rule 2024 is one of the most substantive in recent years, with clarifications, codifications to existing rules and new requirements! Plans need to be well prepared this year…

BluePeak AdvisorsDecember 11, 2023

Claims September 2023

Classifying An Enrollee Billing Complaint as a Grievance, Coverage Request, or Both?

When an enrollee contacts the plan about a provider’s bill, it can be challenging to determine if the enrollee’s issue should be classified as an inquiry or processed under the…

BluePeak AdvisorsSeptember 7, 2023

FDR MA Part D September 2023

Changes to CMS Requirements for Translation and Alternate Formats

To ensure effective communication and meaningful access, Medicare Advantage (MA) and Prescription Drug Plans (PDPs) have been obligated to follow various, occasionally interconnected directives for translating member documents into different…

BluePeak AdvisorsSeptember 7, 2023

PBM September 2023

2024 National Average Monthly Bid Amount Impact

On July 31, 2023, Centers for Medicare & Medicaid Services (CMS) released the National Average Monthly Bid Amount (NAMBA) for contract year (CY) 2024. For 2024, the national average bid…

BluePeak AdvisorsSeptember 7, 2023

June 2023 TPMO

Third Party Marketing Organization (TPMO) Requirements – Not just a Sales Department Responsibility

If it seems as though the Centers for Medicare and Medicaid Services (CMS) has increased its focus, oversight and scrutiny on the marketing practices of some agents and brokers for…

BluePeak AdvisorsJune 1, 2023