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BluePeak Bulletin

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 and news alerts.

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Annual CPE Audit – Compliance as a Strategic Asset

| Compliance & Regulatory Updates, Leadership & Organizational Insights, Winter 2025 | No Comments
Annual CPE audits are required by CMS, but their value goes beyond compliance. These audits assess the effectiveness of your compliance program, identify gaps, and prevent fraud, waste, and abuse.…

Stars – Driving Growth, Revenue, and Reputation

| Leadership & Organizational Insights, Quality & Star Ratings, Winter 2025 | No Comments
Star Ratings are more than numbers—they determine your plan’s financial health, market position, and member loyalty. Every interaction matters, from member experience to clinical outcomes and pharmacy adherence. High ratings…

Secret Shopping – See Your Plan Through the Member’s Eyes

| Medicare Advantage Operations, Member Experience / CAHPS, Winter 2025 | No Comments
Secret shopping is one of the most effective ways to understand how your plan performs in real-world scenarios. By posing as prospective members, these evaluations reveal whether your call center…

Readiness Checklist – Your Roadmap to 2026 Compliance

| CMS Audit Readiness, Leadership & Organizational Insights, Winter 2025 | No Comments
The CMS Readiness Checklist is more than a compliance requirement—it’s your blueprint for success in 2026. This tool ensures your organization is prepared to meet updated regulations, deliver accurate benefits,…

Year-End Benefit Testing – Accuracy Before January 1

| Medicare Advantage Operations, PBM & Pharmacy Compliance, Winter 2025 | No Comments
Year-end testing is essential to validate claims accuracy, ensure compliance with IRA mandates, and confirm PDE reporting integrity. This process guarantees that your systems are prepared for the new contract…

Mock Audits – Stress-Test Before CMS Does

| CMS Audit Readiness, Compliance & Regulatory Updates, Winter 2025 | No Comments
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…

Medicare Part D Redesign: Navigating the Changes in 2025

| Spring 2025 | No Comments
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…

Understanding Non-Quantitative Treatment Limitations (NQTLs) and How BluePeak Advisors Can Help

| Spring 2025 | No Comments
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)…

Annual CPE Audit – Compliance as a Strategic Asset

| Compliance & Regulatory Updates, Leadership & Organizational Insights, Winter 2025 | No Comments
Annual CPE audits are required by CMS, but their value goes beyond compliance. These audits assess the effectiveness of your compliance program, identify gaps, and prevent fraud, waste, and abuse.…

Stars – Driving Growth, Revenue, and Reputation

| Leadership & Organizational Insights, Quality & Star Ratings, Winter 2025 | No Comments
Star Ratings are more than numbers—they determine your plan’s financial health, market position, and member loyalty. Every interaction matters, from member experience to clinical outcomes and pharmacy adherence. High ratings…

The Model of Care Overhaul You Can’t Afford to Delay: Why 2025 Demands a Mock Audit Mindset

| Summer 2025 | No Comments
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…

2025 Audit Insights: Elevating Call Center Performance with FCR and QOC Grievance Management

| Summer 2025 | No Comments
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…

Year-End Benefit Testing – Accuracy Before January 1

| Medicare Advantage Operations, PBM & Pharmacy Compliance, Winter 2025 | No Comments
Year-end testing is essential to validate claims accuracy, ensure compliance with IRA mandates, and confirm PDE reporting integrity. This process guarantees that your systems are prepared for the new contract…

Navigating CMS Audits: Strategic Preparation for 2026

| Summer 2025 | No Comments
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…

Secret Shopping – See Your Plan Through the Member’s Eyes

| Medicare Advantage Operations, Member Experience / CAHPS, Winter 2025 | No Comments
Secret shopping is one of the most effective ways to understand how your plan performs in real-world scenarios. By posing as prospective members, these evaluations reveal whether your call center…

Readiness Checklist – Your Roadmap to 2026 Compliance

| CMS Audit Readiness, Leadership & Organizational Insights, Winter 2025 | No Comments
The CMS Readiness Checklist is more than a compliance requirement—it’s your blueprint for success in 2026. This tool ensures your organization is prepared to meet updated regulations, deliver accurate benefits,…

Mock Audits – Stress-Test Before CMS Does

| CMS Audit Readiness, Compliance & Regulatory Updates, Winter 2025 | No Comments
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…