BluePeak Advisors, Author at BluePeak Advisors

CMS Compliance PBM PDE

The PDE Submission Deadline is Rapidly Approaching-Don’t Assume a High Acceptance Rate Translates to PDE Accuracy

The 2021 PDE submission deadline is June 29, 2022. Plans must attest to the accuracy of their submitted PDE records prior to CMS’ financial reconciliation. The challenge is that many…

BluePeak AdvisorsFebruary 12, 2022

CMS Medicare Part D

Two Rules With Potential Part D Rebate Access Impact

Two rules have the potential to impact how Part D price concessions and pharmaceutical rebates are managed and how these changes, when implemented, will subsequently impact a Part D sponsor’s…

BluePeak AdvisorsFebruary 9, 2022

Audits CMS Medicaid Medicare

Program Audit Consistency Teams (PACTs)

In the ‘2022 Program Audit Process Overview’1 document, the Centers for Medicare & Medicaid Services (CMS) shared that they will send engagement letters to initiate routine audits beginning February 2022 through…

BluePeak AdvisorsFebruary 9, 2022

CMS HPMS Part D

Annual Transition Policy and Attestation Submission to CMS

The Centers for Medicare and Medicaid Services (CMS) requires, as part of the formulary submission process, each plan sponsor complete the Transition Policy Attestation through the formulary submission module in…

BluePeak AdvisorsFebruary 9, 2022

Claims Medicare

Why Medical Claims Audits?

In view of ever rising benefit costs, employers and Medicare Advantage plans should consider a medical claims audit as part of an overall benefits and cost-containment strategy. Medical claims audits…

BluePeak AdvisorsFebruary 9, 2022

Tips

Top 5 Tips to Prevent a Part D Transition Finding

Transition is highly scrutinized and frequently audited within the Medicare Part D program. For 2021, the Centers for Medicare & Medicaid Services (CMS) performed the Transition Requirements Analysis (TRA) to…

BluePeak AdvisorsDecember 17, 2021

Legal Summaries

Big Changes Ahead for Group Health Plans and Individual Health Plans

The following are summaries of Rules that contain big changes for group health plans and individual health plans. SummaryInterim Final Rule with Comment Period Requirements Related to Surprise Billing; Part…

BluePeak AdvisorsJuly 29, 2021

ACA CMS CSR FFE

Significant Changes Proposed for Qualified Health Plans

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule titled “Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving…

BluePeak AdvisorsJuly 12, 2021

HHS

HHS Comes Full Circle: Section 1557 Regulations Again Interpreted to Prohibit Discrimination Based on Sexual Orientation and Gender Identity

On May 25, 2021, the Department of Health and Human Services (HHS) announced that it would again interpret and enforce the Section 1557 of the Affordable Care Act (Section 1557)…

BluePeak AdvisorsMay 26, 2021

CMS HPMS MCMG

In Case You Missed It! CMS New Marketing Module Training–Big Changes Coming

On Friday May 28th, at 5pm ET, CMS will provide Plan Sponsors access to the new HPMS marketing module. The new marketing material module has enhanced functionality and will provide…

BluePeak AdvisorsMay 26, 2021