Care Management

CMS Finalizing Transparency Rule: What Will You Get to See?

The Centers for Medicare & Medicaid Services (CMS) issued a proposed final rule on November 15 that requires hospitals to disclose the rates they negotiate with health insurers beginning in…

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NCQA Updates Health Plan Accreditation for 2020

Improvements to evaluating health plans and increasing transparency. Focus on implementing standards and achieving outcomes. Reducing the administrative burdens for health plans. These are all prominent goals for NCQAs Health…

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NCQA Distinction: Helping Coordinate LTSS

More than 3 million people in the United States rely on Medicaid for Long-Term Services and Support (LTSS) in nursing homes, home care, and community-based settings. LTSS supports people with…

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What Do NCQA’s Five-Star Ratings Mean?

There are numerous rating systems these days: Rating the top movies, the best restaurants, or that little yellow full-or-half-star on popular e-commerce sites that indicate how satisfied customers were with…

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Challenges with Health Plan Re-accreditation

As NCQA Health Plan re-accreditation quickly approaches for many health plans this year, in addition to ensuring certain areas are accreditation ready, the quality and clinical teams at your health…

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Is Your Population Health IT Platform Optimized?

If you are a Population Health Operations Vice President, Director or Manager, and you’ve had your current population health solution for five years or more does the following ring true…

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MDM Implementations: Steps for Success

What is the most important aspect to address for any successful MDM implementation? For those of us who work closely within client MDM environments, we’d probably all agree that it’s the pre-work that healthcare teams…

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Using Technology to Transform Prior Authorization

Prior authorization is the process providers use to request pre-approval by health plans for health services payment for their patients. Like other areas of healthcare, prior authorization is entering a…

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Understanding NCQA’s Population Health IT Prevalidation Program

Is your organization an NCQA-accredited health plan, or a managed behavioral health, care management or population health vendor? Is your healthcare organization shopping for a new population health IT vendor?…

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