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Composing a Compliant 2019 ANOC/EOC

July 26, 2018 Marissa Feigen Compliance & Reporting, Health Insurance

The Model Documents released by CMS each year offer instructional guidance and standardized document templates for the member materials that must be distributed each fall by Medicare Advantage, Medicare Advantage Prescription Drug, […]

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CMS Decreases Regulatory Burden to Increase Innovation

April 30, 2018 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

“Regulations do have their role. They’re very important to assuring patient safety and quality and for program integrity, but there’s a fine line between being helpful and being a hindrance,” […]

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CMS Intensifies Provider Directory Penalties: 2019 Draft Call Letter

March 6, 2018 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

The Centers for Medicare and Medicaid Services (CMS) requires plans to monitor and conduct regular updates of their provider network data, including updating providers’ ability to accept new patients, as […]

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Converting 2018 MMG Change into Savings Opportunity

December 20, 2017 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

September 30th has long passed, but now is the time to reflect on your ANOC/EOC fulfillment processes in order to implement new efficiencies for next year. As a full-service member […]

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Five Steps to Building Digital Trust

May 30, 2017 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

From the 11 million Premera members to the 80 million Anthem consumers effected by a cyber attack, security breaches are on the rise in healthcare and insurers are just as […]

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NAIC Places Network Adequacy Determination with the States

June 14, 2016 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

Finalized on November 22, 2015 after 18 months of discussion, the National Association of Insurance Commissioners (NAIC) approved an updated version of its Managed Care Plan Network Adequacy Model Act. […]

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2016 Provider Directory Accuracy & Network Adequacy Requirements

May 11, 2016 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

Pre-2016 Medicare Advantage network adequacy guidance simply states that plans must maintain a network of providers “sufficient to provide adequate access to covered services to meet the needs of the […]

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2017 MA Final Call Letter: Provider Directory Requirements Update

May 11, 2016 Marissa Feigen Compliance & Reporting, Health Insurance

The 2017 Final Call Letter to Medicare Advantage Organizations (MAOs) continued to emphasize the importance of provider directory accuracy and the increased monitoring and enforcement actions to commence due to […]

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CMS Strengthens Provider Directory Standards

December 23, 2015 Marissa Feigen No comments yet Compliance & Reporting, Health Insurance

Beginning January 1, 2016, CMS will be strengthening their benchmarks for provider network data. This is due to a year plagued with consumer complaints regarding misleading provider network data in […]

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