Keep your At-Risk Members Healthy while improving your HEDIS and STAR Ratings

Keep your At-Risk Members Healthy while improving your HEDIS and STAR Ratings Diabetes is a chronic disease that can create downstream health issues if not carefully watched and addressed. In fact, according to the CDC, over 29 million, or 9.3% of the US population suffer from type 2 diabetes. [1] Diabetic patients need to be aware of their elevated risk ...

Federal Governments Requirements for QHPs and Provider Directories – Don’t Panic (Yet).

Vice PresidentJosh HolmesWhat You Need to Know:On Feb. 20, 2015, 2015 the Centers for Medicare & Medicaid Services (CMS) released two distinct rules regarding online directories.  According to the rule, Medicare Advantage Organizations will be required to contact providers on a quarterly basis (90 days) beginning next year and be expected to update online directories in real-time. The rule also ...

Provider Data 911 – ACA Marketplace Health Plans’ Dilemma

The ACA (Affordable Care Act) has significantly increased the number of consumers participating in an already overburdened healthcare delivery system.  While it has provided significantly increased access to a wider range of health insurance benefits than has ever before been available, it has also added increased complexity.  The onus is on health insurance providers and payers to provide networks sufficient …