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As your organization delves into the intricacies of the 2025 Final Rule and Rate Announcement, remember that proactive adaptation is vital.

The CMS released its Interoperability and Prior Authorization final rule (CMS-0057-F). Learn what this means for payers and providers.

Get an overview of key OIG findings, tips for MAOs to avoid similar pitfalls, and what to expect in 2024 with the updated risk adjustment model.

With the right combination of continuous operational scrutiny and performance management solutions like the Jiva Care Quality Navigator, plans can improve.

Patient Access and Interoperability bring hundreds of payers and app developers into an emerging ecosystem that will continue to mature.

See how new technologies enable nurse informaticists, health plans, providers, and community-based resource organizations to improve processes.

Medicaid is the largest health insurance program in the U.S., covering approximately one in five Americans. That equates to 82.3 million low-income Americans, including millions of children, older adults, people with disabilities, and two million veterans. Medicaid is the single

Claw Backs and Beneficiary Protections in the Form of CMS Regulatory Changes – Massive Financial Implications

Much of the direction of the 2020 proposed rule is in the new proposed rule, particularly the sharing of prior authorization decisions/status with patients.

The Centers for Medicare and Medicaid (CMS) released the 2024 Medicare Advantage Proposed Rule on December 14, 2022 and the 957 page document is scheduled to enter the federal register on December 27th, 2022.

To reduce the burden of the prior authorization, many providers and payers have come together to develop solutions. Learn more.

Contact rates for case managers were better than 50%, yet actual enrollment in our programs was less than 10%.

Measure year 2022 saw record-breaking numbers of Medicare Advantage (MA) health plans achieving five-Star Ratings, but with pandemic adjustments—which focused on pre-COVID-19 data.