BluePeak Advisors, Author at BluePeak Advisors

Summer 2025

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…

BluePeak AdvisorsAugust 6, 2025

Uncategorized

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…

BluePeak AdvisorsJuly 21, 2025

Spring 2025

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)…

BluePeak AdvisorsMarch 25, 2025

Spring 2025

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…

BluePeak AdvisorsMarch 25, 2025

Archive

Proposed Rule Re: Medicare Program

Proposed Rule Re: Medicare Program; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive…

BluePeak AdvisorsDecember 11, 2024

Archive

Risk-Adjustment Data Validation Readiness: Key Strategies for Compliance

Did you know that there are publicly accessible resources identifying highly scrutinized Hierarchical Condition Category (HCC) codes that may be problematic for your plan? Did you know there’s an annual…

BluePeak AdvisorsDecember 11, 2024

Archive

Navigating the Future of Utilization Management Requirements

As 2024 comes to a close, the Centers for Medicare & Medicaid Services (CMS) Utilization Management (UM) requirements remain as high priority, and 2025 brings with it new considerations for…

BluePeak AdvisorsDecember 11, 2024

Archive

Medicare Prescription Payment Plan – Are you ready for it?

The Inflation Reduction Act (IRA) introduced several changes to the Medicare landscape. One of the biggest changes that impacts members and plans alike is the Medicare Prescription Payment Plan (MPPP)…

BluePeak AdvisorsDecember 11, 2024

Archive

Part D Audit Insights for CY2024: Key Takeaways

As the CY2024 audit season wraps up, the Centers for Medicare and Medicaid Services (CMS) has been publishing both draft and final reports for those selected for program audits. We…

BluePeak AdvisorsSeptember 23, 2024

Archive

Should Off-cycle MOC Submission Be a Priority, RIGHT NOW?

December 1, 2024, signals closure of the 2024 the National Committee for Quality Assurance (NCQA) Model of Care (MOC) Off-Cycle submission window, but there is still time to update if you…

BluePeak AdvisorsSeptember 23, 2024