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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Top Medicare Advantage Plan Strategies for 2026 CMS Audit Changes
Medicare Advantage organizations facing program audits in 2026 will encounter an unusual batch of changes. These changes, revealed in a November CMS memo, are intended to streamline the process and…
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Annual CPE Audit – Compliance as a Strategic Asset
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.…
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Secret Shopping – See Your Plan Through the Member’s Eyes
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…
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The Model of Care Overhaul You Can’t Afford to Delay: Why 2025 Demands a Mock Audit Mindset
If your Model of Care (MOC) was written before 2025, it’s already outdated.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…
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Medicare Part D Redesign: Navigating the Changes in 2025
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…
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Readiness Checklist – Your Roadmap to 2026 Compliance
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,…
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Understanding Non-Quantitative Treatment Limitations (NQTLs) and How BluePeak Advisors Can Help
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)…
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Top Medicare Advantage Plan Strategies for 2026 CMS Audit Changes
Medicare Advantage organizations facing program audits in 2026 will encounter an unusual batch of changes. These changes, revealed in a November CMS memo, are intended to streamline the process and…
Read More
Annual CPE Audit – Compliance as a Strategic Asset
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.…
Read More
Year-End Benefit Testing – Accuracy Before January 1
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…
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2025 Audit Insights: Elevating Call Center Performance with FCR and QOC Grievance Management
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…
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Secret Shopping – See Your Plan Through the Member’s Eyes
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…
Read More
News Alerts
- October 1, 2025 | Federal Government Shutdown – What It Means for Medicare Advantage Plans
- July 30, 2025 | Navigating Medicare Part D in 2026: Key Updates and Strategic Implications
- July 22, 2025 | CMS has Released Proposed Updates to the PACE Audit Protocol
- July 17, 2025 | CMS Just Released Updated Model of Care Documents
- July 16, 2025 | CMS 2024 Enforcement Actions Announced
- May 6, 2025 | Turn Compliance Challenges into Opportunities: Elevate Your Medicare Strategy!
As we navigate the evolving landscape of healthcare regulations, BluePeak is dedicated to helping you manage these complexities and ensure compliance with all requirements. We are preparing a special edition to deliver the latest updates and insights directly to your inbox. Subscribe today to stay informed.