Part D Archives - Page 3 of 5 - BluePeak Advisors

CMS Medicare Part D

Initial Adoption of Indication-Based Formularies as a Formulary Management Tool

In August of 2018, CMS announced that Medicare Part D Sponsors have the option to use indication-based formularies starting January 1, 2020. Prior to this change, formulary medications were considered…

BluePeak AdvisorsApril 29, 2020

CMS Part C Part D

Provider Directory Accuracy Monitoring and Use of the National Plan & Provider Enumeration System (NPPES)

On March 11, 2020 the CMS Part C and D User Call focused on Provider Directory accuracy and how the NPPES may support such accuracy. In case you missed it,…

BluePeak AdvisorsMarch 18, 2020

CMS IDS Part C Part D UMS

Universe Monitoring Service Case Study and Service Spotlight

Many of the proposed audit protocol changes for both the 2020 and 2021 audit season included changes to universes. An incomplete and incorrect universe can add 1 point toward your…

BluePeak AdvisorsMarch 18, 2020

CARA CDAG FA Opioids Part D

Is Your Opioid Program Compliant?

In 2019, Medicare introduced new policies for opioid prescriptions in the Medicare Part D prescription drug program to encourage pharmacies, prescribers, and Medicare drug plans to work together with the…

BluePeak AdvisorsMarch 18, 2020

Audits Call Log Review CMS Part C Part D Star Ratings

Accurate Call Classification and Handling-Strategies for Evaluating and Monitoring Your Customer Service Team

The Centers for Medicare & Medicaid Services (CMS) released an HPMS memo on August 20, 2019 providing an overview of the upcoming changes to program audits through 2021. These changes…

BluePeak AdvisorsMarch 18, 2020

DMP MA PACE Part C Part D RTBT

10 Things Plans Need to Know about the 2021 and 2022 Policy and Technical Changes Proposed Rule

On February 5, 2020, the Centers for Medicare & Medicaid Services (CMS) announced it will not be publishing a Call Letter for 2021. Rather, CMS is codifying guidance typically published…

BluePeak AdvisorsFebruary 25, 2020

CARA CMS MME OMS Opioids Part D

Ensuring a Pain-free Opioid Safety Strategy

In 2019, Medicare introduced new policies for opioid prescriptions in the Medicare Part D prescription drug program to encourage pharmacies, prescribers, and Medicare drug plans to work together with the…

BluePeak AdvisorsDecember 17, 2019

CMS Data Reporting IRE Part C Part D

Got Data?

Independent Review Entity (IRE) Transparency Initiative Plans are continuously looking for data to better understand their appeals outcome. The IRE transparency initiative provides plans with several more tools. During the…

BluePeak AdvisorsDecember 17, 2019

CMS FWA Medicare Part B Part C Part D

CMS Fraud Conference–Working Together to Combat Fraud

From July 16-18th over 100 investigative minds met at the annual CMS Fraud Conference in Miami, Florida to talk about current fraud schemes, emerging schemes, data analytics and how to…

BluePeak AdvisorsAugust 2, 2019

Compliance IRE MA MA-PD Part D PBM

Using Interim Staffing to bring Appeals and Grievances Timeliness into Compliance–A Case Study

Sometimes, life happens. Turnover, volume increases, changing guidance, system changes or audit issues that require remediation all can create situations where a Plan or PBM needs expert resources fast. And…

BluePeak AdvisorsMarch 15, 2019