Utilization Management Archives

Part D Utilization Management Winter 2024

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

Summer 2024 Utilization Management

2024 Utilization Management (UM)- Focused Audits: Lessons Learned

The annual Centers for Medicare and Medicaid Services (CMS) Audit Season has been in full swing since the beginning of the year with a focus on Utilization Management. CMS is…

BluePeak AdvisorsJune 24, 2024

Audits Medicare Part D Spring 2024 Utilization Management

What Risk Does the new TERM Table Really Pose?

Have you heard about the new table initially required in the CMS Utilization Management (UM)-Focused audits? Also, known as “Table 7”, Plans need to ensure an ability to report accurate…

BluePeak AdvisorsMarch 29, 2024

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