Government Sponsored Programs - MedicarE

Medicare Bids, PDP, and Operations

Medicare Bids, PDP, and Operations Medicare Bids & Part D Support

• Program assessment to reduce overall drug costs and improve plan pharmacy operations.
• Develop best practices leveraging encounters and recent Inflation Reduction Act changes

Operational Compliance Support

• Evaluations of operational processes are needed to ensure MCOs processes are in-line with CMS regulations and guidance.
• Conduct mock-audits to ensure readiness
• Recommend business process design and improvement for areas requiring optimization

Risk Revenue Capture

• Leverage CMS risk adjustment models, analyze health plan enrollment and claims to identify missed opportunities for CMS risk payments.
• Ensure the persistency and accuracy of conditions submitted to CMS.
• Adherence to CMS Risk Adjustment Validation guidelines to ensure the plan can withstand any audit scrutiny of submitted data.

Stars Program Evaluation and Support

• Health plan operations reviewed and supplemented with industry best practices to ensure 4+ Star performance.
• Identify gaps and design solutions to remediate operating model changes
• Deliver higher performance and better member outcomes.