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BluePeak Insights

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, news alerts, ad hoc insight articles, and Case Studies.

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March 31, 2026 in Newsletter Q1 2026

2027 CMS Audit Shake‑Up: The Time to Prepare Is Now

The proposed 2027 audit protocols redefine CMS’s expectations for Medicare Advantage (MA) and Part D plans. With expanded MA and Part D data requirements, including CMS’s intent to leverage all…
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March 31, 2026 in Newsletter Q1 2026

Introducing the ADVISE Framework – Six Imperatives for 2027 Audit Readiness

To help plans, delegates, and PBMs navigate what’s ahead, BluePeak has developed the ADVISE Framework, a practical, action oriented readiness model aligned to the operational challenges highlighted in the proposed…
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March 31, 2026 in Newsletter Q1 2026

ICYMI: CY 2027 Model of Care — What SNP Plans Need to Know

Why CY 2027 Is Different On March 26, 2026, BluePeak provided a free webinar on 2027 MOC Readiness.  During the webinar, Beth Brooks, Director of Medicare Part C, emphasized that…
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March 31, 2026 in Newsletter Q1 2026

MFN Pricing Moves from Policy to Practice: What GUARD Means for Medicare Part D

CMS is entering a new phase of federal drug pricing reform, moving the Most Favored Nation (MFN) concept from policy signaling into direct implementation. For Medicare Part D stakeholders, the…
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March 13, 2026 in Insight Article

5 Actions to Take Now for a Strong 2027 Medicare Advantage Bid

With Medicare Advantage bids due June 1 for the 2027 plan year, plan sponsors face a compressed window in which they must complete numerous activities amid medical cost trend and…
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March 25, 2025 in Compliance & Regulatory Updates

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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July 21, 2025 in CMS Audit Readiness

Important: Opportunity for PACE Organizations to Comment on CMS Proposed Updates

CMS has announced a 30-day comment period for the proposed collection entitled “The PACE Organization (PO) Monitoring and Audit Process” (CMS-10630; OMB control number: 0938–1327). This notice was published on…
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August 6, 2025 in Compliance & Regulatory Updates

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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August 6, 2025 in CMS Audit Readiness

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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August 6, 2025 in CMS Audit Readiness, Compliance & Regulatory Updates, Compliance Program Effectiveness

Navigating CMS Audits: Strategic Preparation for 2026

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…
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December 3, 2025 in CMS Audit Readiness, Compliance & Regulatory Updates, Winter 2025

Mock Audits – Stress-Test Before CMS Does

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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December 3, 2025 in Medicare Advantage Operations, PBM & Pharmacy Compliance, Winter 2025

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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December 3, 2025 in CMS Audit Readiness, Leadership & Organizational Insights, Winter 2025

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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December 3, 2025 in Medicare Advantage Operations, Member Experience / CAHPS, Winter 2025

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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