Industry News

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Arthur J. Gallagher & Co. Acquires BluePeak Advisors, LLC

BluePeak is pleased to announce our most significant move yet to enhance the services we bring to our valued clients. Effective today, BluePeak Advisors has merged with Gallagher. With operations in more than 35 countries and client-service capabilities in more than 150 countries, Gallagher is a Fortune…

BluePeak AdvisorsJuly 10, 2019

LinkedIn Uncategorized

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

Looking for more articles and insight from us? Head over to our LinkedIn page to discover more. Here are some of the recent articles posted there: Audit Tip #3-- It’s…

BluePeak AdvisorsJune 19, 2019

HPMS Medicare PDBM

Medicare Advantage and Prescription Drug Plan Appeals Guidance– Are You Ready?

Chapter 13 of the Medicare Managed Care Manual (MMCM) and Chapter 18 of the Prescription Drug Benefit Manual (PDBM) have been consolidated into one chapter. CMS announced the release of…

BluePeak AdvisorsJune 12, 2019

CMS Medicaid Medicare

Call Centers Beware

On May 10, 2019, CMS published a final rule on Drug Pricing Transparency. The rule, effective July 9, 2019, requires direct-to-consumer television advertisements of prescription drugs and biological products payable…

BluePeak AdvisorsJune 11, 2019

Legal PBM

Question & Answer

Q: Is it permissible for the Compliance Officer to report to General Counsel or the Legal Department? A: While some Plans and PBMs do this, it is not ideal or…

BluePeak AdvisorsJune 11, 2019

Service Spotlight

Service Spotlight: Member Material Review

Are you drowning in developing and reviewing member material? Accuracy and timeliness are critical in all member communications. BluePeak’s consultants have experience reviewing member materials from their work at Plans…

BluePeak AdvisorsJune 11, 2019

CMS HPMS MA

Changes Ahead for Plan Finder

During the CMS Spring Conference on May 1, 2019, CMS reviewed some of the revisions that are being made to Plan Finder. The redesigned Plan Finder will be used this…

BluePeak AdvisorsJune 11, 2019

CHIP CMS HHS MA MA-PD QHP

Interoperability Rule-This Could Be a Big Deal!

The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have published several new proposed and final rules on various topics, ranging from prescription…

BluePeak AdvisorsJune 11, 2019

Audits CMPs HIPAA OCR

Is Your Organization Doing All You Can to Detect, Prevent and Correct HIPAA Violations?

On April 30, 2019, Health and Human Services (HHS) published a final rule in which they are exercising their discretion in how they apply regulations concerning the assessment of Civil…

BluePeak AdvisorsJune 11, 2019

CMS Marketing MCMG PDE Training

BluePeak’s Definitive Guide to Preparing for 2020

Bids were turned in the first Monday in June and now it is time to implement those benefits, plan designs and formularies that your organization has been hard at work…

BluePeak AdvisorsJune 11, 2019

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

Looking for more articles and insight from us? Head over to our LinkedIn page to discover more. Here are some of the recent articles posted there: CMS Announces Timeliness Monitoring…

BluePeak AdvisorsMarch 15, 2019

Audits CMS

BluePeak Service Spotlight: Universe Monitoring Service

On February 8, 2019, CMS released “CMS Program Audits Frequently Asked Questions (FAQs). One of the questions addressed was: “Will sponsoring organizations always have the opportunity to submit universes up…

BluePeak AdvisorsMarch 15, 2019

Audits CDAG CMS CPE FA ODAG SARAG SNP-MOC

The 2019 CMS Program Audit Season is Upon Us!

CMS started issuing audit letters in March and will continue doing so through July. If you haven't already received an audit notice, what are you doing to prepare? 2019 starts…

BluePeak AdvisorsMarch 15, 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

Audits CMS Tips

I really hope I get a CMS Program Audit notice this season… Said no one ever!

But, ready or not, CMS Program Audit Season is here! Wouldn’t it be great to know that you have done everything possible to prepare in the event you get a Program Audit notice?…

BluePeak AdvisorsMarch 15, 2019

Call Letter CMS DMP Medicaid Medicare MME Part C

CMS Continues Along Its Roadmap to Address the Opioid Epidemic

Effective January 1, 2019, the Centers for Medicaid & Medicare Services (CMS) required plan sponsors to implement new opioid policies as part of the agency’s continued efforts to address the…

BluePeak AdvisorsMarch 15, 2019

CMS FDRs HPMS Medicaid Medicare Star Ratings TPMA

Potential Changes on the Horizon for 2020 and Beyond

After getting ready for all the changes a new contract year brings, Medicare Advantage (MA) Plans and Part D sponsors await the issuance of the Draft Call Letter for early…

BluePeak AdvisorsMarch 15, 2019

CMS MA Medicare Part D PDP

Drum Roll Please…The 2019 Medicare Enrollment Numbers are In.

2019 is already off to a blazing start with the implementation of Medicare Part D plans’ new opioid edits as well as 2020 formulary development. While plans are already preparing…

BluePeak AdvisorsFebruary 8, 2019

FDRs Medicare Part D Uncategorized

Ensuring Record Retention Requirements with First-tier, Downstream and Related Entities (FDR’s).

Many Medicare Plans may believe compliance with the ten-year record retention requirement is a slam-dunk. However, plans are often tripped up in audits because their first-tier and downstream entities do…

BluePeak AdvisorsFebruary 1, 2019

HIPAA OCR

BluePeak Service Spotlight: HIPAA Program Review

HIPAA Violations = Potential Civil Fines and Criminal Penalties How healthy is your HIPAA Program? BluePeak’s HIPAA Program Review can help you identify and correct privacy, security and breach policy and procedure issues that might leave…

BluePeak AdvisorsDecember 7, 2018

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

Looking for more articles and insight from us? Head over to our LinkedIn page to discover more. Here are some of the recent articles posted there: Claim Accuracy is More…

BluePeak AdvisorsDecember 7, 2018

CMS Part D

Prepared to Implement the CMS Preclusion List Requirement?

Along with the new year also comes a new CMS requirement known as the Preclusion List. This requirement was adopted in the April 2018 final rule as an alternative to…

BluePeak AdvisorsDecember 3, 2018

Medicare Part C Part D

5 Universal Strategies to Move the Needle on Star Rating Improvements: A Medication Adherence Case Study

One of the surprises in the release of plans’ Star Ratings results for the 2019 open enrollment season was that Star Ratings around Part D adherence scores, on average, slipped.…

BluePeak AdvisorsDecember 1, 2018

CMS MBI Medicare Open Enrollment Part D

Is Your Plan Ready for the New Year?

Annual Notices of Changes (ANOC) shared with enrollees Evidence of Coverage (EOC) shared with enrollees Formulary shared with enrollees Pharmacy and Provider Directories shared with enrollees Medicare Communications Marketing Guidelines…

BluePeak AdvisorsDecember 1, 2018

CMS EOC FDA Part D

Formulary Strategy Planning for 2020-Indication Based Formulary Design Considerations

The 2019 plan year has not commenced, yet plans are already developing formulary strategies for 2020. Indication-based formulary designs will add a new twist for plan sponsors to consider as…

BluePeak AdvisorsDecember 1, 2018

CMS TPMA Uncategorized

Transition Monitoring Program Audit-Coming Soon!

History and Methodology The transition monitoring program analysis (TMPA) has been in effect since 2012 and will likely be a staple in the Part D program for several years to…

BluePeak AdvisorsDecember 1, 2018

CMS Medicare Part C Part D PBM

Proposed Rule Aimed at Drug Price Transparency Could Lead to Inadvertent Member Confusion

On October 18, 2018, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule which, if finalized, will amend the Medicaid and Medicare Parts A, B, C, and…

BluePeak AdvisorsNovember 22, 2018

CMS Marketing MCMG

BluePeak’s Summary of the September 2018 Medicare Communications and Marketing Guidelines (MCMG)

On July 20, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released the Medicare Communications and Marketing Guidelines (“MCMG”), replacing the Medicare Marketing Guidelines and all associated guidance in…

BluePeak AdvisorsSeptember 25, 2018

EHR EMR MPF Part C Part D Star Ratings

What are you doing to improve your Star Ratings?

As you checked your plan data that will be displayed on Medicare Plan Finder (MPF) for accuracy during the recent second plan preview, were you happy with your Star Ratings?…

BluePeak AdvisorsSeptember 21, 2018

CMS MAT Medicare MME Opioids Part D PBM

CMS Continues to Deploy Revised Strategies to Assist with Identifying and Deterring Opioid Abuse

To assist Medicare Part D sponsors with monitoring efforts and potentially avoid overutilization of opioids in the elderly Medicare population, CMS has deployed numerous strategies over the past several years…

BluePeak AdvisorsSeptember 21, 2018

Arthur J. Gallagher & Co. Acquires BluePeak Advisors, LLC

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

Medicare Advantage and Prescription Drug Plan Appeals Guidance– Are You Ready?

Call Centers Beware

Question & Answer

Service Spotlight: Member Material Review

Changes Ahead for Plan Finder

Interoperability Rule-This Could Be a Big Deal!

Is Your Organization Doing All You Can to Detect, Prevent and Correct HIPAA Violations?

BluePeak’s Definitive Guide to Preparing for 2020

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

BluePeak Service Spotlight: Universe Monitoring Service

The 2019 CMS Program Audit Season is Upon Us!

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

I really hope I get a CMS Program Audit notice this season… Said no one ever!

CMS Continues Along Its Roadmap to Address the Opioid Epidemic

Potential Changes on the Horizon for 2020 and Beyond

Drum Roll Please…The 2019 Medicare Enrollment Numbers are In.

Ensuring Record Retention Requirements with First-tier, Downstream and Related Entities (FDR’s).

BluePeak Service Spotlight: HIPAA Program Review

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

Prepared to Implement the CMS Preclusion List Requirement?

5 Universal Strategies to Move the Needle on Star Rating Improvements: A Medication Adherence Case Study

Is Your Plan Ready for the New Year?

Formulary Strategy Planning for 2020-Indication Based Formulary Design Considerations

Transition Monitoring Program Audit-Coming Soon!

Proposed Rule Aimed at Drug Price Transparency Could Lead to Inadvertent Member Confusion

BluePeak’s Summary of the September 2018 Medicare Communications and Marketing Guidelines (MCMG)

What are you doing to improve your Star Ratings?

CMS Continues to Deploy Revised Strategies to Assist with Identifying and Deterring Opioid Abuse

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