Stay informed with the latest compliance strategies, CMS updates, and tips to keep your healthcare team ahead.
The Formulary Administration audit looks at what your PBM rejected, what got transitioned, and whether members were notified on time. A practical walkthrough of where most plans get tripped up.
A practical walkthrough of the Part D Coverage Determinations, Appeals and Grievances universe. Where it differs from ODAG, the timeliness rules that catch plans off guard, and the data quality issues we see most.
CMS is removing 11 measures from Star Ratings and scrapping the Health Equity Index reward. Here is what changed, what it means for quality bonus payments, and where oversight is shifting.
Why manually cross-referencing CMS memos to your P&P library creates audit exposure, and how AI-powered policy intelligence gives compliance teams a systematic, documentable process.
CMS posted nearly $2.9M in MA/Part D fines by early April 2025, matching all of 2024. Learn what's driving enforcement and how plans can strengthen compliance.
Our security controls have been independently audited and validated as operating effectively over time. Here's what SOC 2 Type II means for our customers and why it matters for health plans handling sensitive CMS data.
A practical walkthrough of all 6 ODAG universe tables: OD, Reconsiderations, Payment, Effectuations, Grievances, and AIP. Learn what each table captures, which fields matter most, and where plans commonly get tripped up.
With CMS eliminating audit scoring and ICAR/ORCA classifications, Invalid Data Submission (IDS) becomes even more critical. Learn what triggers IDS findings and how to prevent them before February 2026.
Learn how CMS SNPCC audits ensure Special Needs Plans deliver coordinated care. Understand the 13 CMS standards, HRA timeliness requirements, and how to build a proactive compliance program.
Under CMS's 2026 "Collaborating on Compliance" model, your COA universe becomes the foundation for every discussion with auditors. Learn what the 12 COA data elements mean, common gaps that undermine discussions, and how to prepare before February 2026.
CMS released their 2026 Program Audit Updates memo with significant changes: scoring eliminated, ICAR/ORCA classifications removed, new CPE evaluation approach, and evolved validation audit requirements. Here's what compliance teams need to know.
Learn how to systematically measure Third-Party Administrator performance in CMS universe file validation with actionable metrics to drive continuous improvement and reduce compliance risk.
Honoring the dedication of compliance professionals who safeguard healthcare integrity while navigating an increasingly complex regulatory landscape, including the dramatic expansion of CMS audits in 2025.
Learn how incident management systems help health plans conduct structured fraud, waste, and abuse investigations while promoting a culture of compliance.
The 2026 CMS Program Audit framework reset what compliance means for Medicare Advantage plans. Five challenges every MA compliance team faces this year, and how each maps to the new audit reality.
A 2026 guide to CMS compliance requirements for Medicare Advantage and Part D plans: the new CAR/Observation/IDS framework, universe file submissions, CPE evaluation, and what audit-ready actually means now.
How to prepare for a 2026 CMS Program Audit under the new CAR/Observation/IDS framework. Universe file validation, COA universe readiness, documentation requirements, and during-audit response.
What non-compliance actually costs Medicare Advantage plans: CMS CMPs, contract action, audit-record IDS findings, and the operational and reputational consequences that exceed the headline penalty number.
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