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MA Plans: How to Thrive Under New Prior Auth Regs

Event Date: 12/8/2022

Event Overview

Thursday, December 8, 2022
11:00 AM CT – 12:00 PM CT (60 minutes)
Vendor Spotlight Host: Cohere Health 

In late September, the U.S. House of Representatives passed legislation that would streamline prior authorization requirements under Medicare Advantage plans: The Improving Seniors' Timely Access to Care Act is intended to reduce providers' administrative burden while improving the speed of patient access to necessary care. The final regulations will require MA plans to Implement electronic PA programs that adhere to newly developed federal standards, including (i) issuing real-time PA decisions for items and services that are identified as routinely approved; (ii) accelerating PA decisions for all other services covered under Medicare Part C; and (iii) improving transparency by reporting to CMS on the items and services that require PA, the rate of approvals and denials, and the median and average time required for authorization review.

This webinar and panel discussion will present and discuss strategies for not only meeting these challenging requirements, but also how to leverage those strategies to further improve care access and quality. Some takeaways include:

  • Strategies for automating and consolidating PA to meet real-time decision and TAT requirements
  • Methods of making PA rules and metrics transparent to providers and CMS
  • Leveraging compliance to increase positive impact on Star ratings, from better member experience to faster, better outcomes
  • The additional, unique value of influencing better care choices before services are approved, in the context of the patient's entire care episode or journey

Notice to Participants:
Please note that this webinar is a Vendor Spotlight and will be a capabilities-focused presentation. While this vendor is not under contract with the Health Plan Alliance, we believe this webinar will provide you the opportunity to learn more about this vendor and the programs and services it provides. Offering this webinar does not imply that the Health Plan Alliance endorses this vendor. The webinar is merely for informational purposes only. Should you wish to share feedback and/or have questions about this vendor, please contact Jaime González, the Alliance’s Chief Business Development Officer, at jaime.gonzalez@healthplanalliance.org or 972-830-6355.



 

Thank you to our event sponsors


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Documents
12/9/2022

Recording: MA Plans: How to Thrive Under New Prior Auth Regs
Cohere Health will discuss during this video presentation the expected final passage of the Seniors' Timely Access to Care Act, which will require MA plans to quickly reconfigure or rebuild their UM and prior authorization (PA) operations to comply. Is your MA plan ready for this challenge? Find out from industry experts not only how to comply, but also how to leverage compliance to further improve care quality and member experience.

12/5/2022

Presentation: MA Plans: How to Thrive Under New Prior Auth Regs
Cohere Health will discuss the expected final passage of the Seniors' Timely Access to Care Act, which will require MA plans to quickly reconfigure or rebuild their UM and prior authorization (PA) operations to comply. Is your MA plan ready for this challenge? Find out from industry experts not only how to comply, but also how to leverage compliance to further improve care quality and member experience.

Attendees

Below is a list of all delegates registered to date for this event

  • Staci Alber
  • ALLIANCE MEMBER
  • Compliance Auditing/Monitoring Program Manager at Samaritan Health Plans
  • Sibyl Boyd
  • ALLIANCE MEMBER
  • Medical Department Coordinator/Certified Risk Adjustment Coder at Cox HealthPlans
  • Marty Cerier
  • ALLIANCE MEMBER
  • Director Regulatory Audits and Investigations at Health Alliance Plan (HAP)
  • Tammy Chadd
  • ALLIANCE MEMBER
  • Compliance Manager at IU Health Plans
  • Jacqueline Crews
  • ALLIANCE MEMBER
  • Director, Public Policy & Benefit Contracts at AvMed
  • Ronald Encinares
  • ALLIANCE MEMBER
  • Lead, Project Coordinator at Health Alliance Plan (HAP)
  • Jeremy Fejfar
  • ALLIANCE MEMBER
  • Pharmacy Director Government Programs at Quartz Health Solutions
  • Deb Foster
  • ALLIANCE MEMBER
  • Executive Director Population Health Care Management/Utilization Management at IU Health Plans
  • Justin Fowler
  • ALLIANCE MEMBER
  • Director UM at Community Health Plan of Washington
  • Janice Gaynor
  • ALLIANCE MEMBER
  • RN Supervisor at Health Alliance Plan (HAP)
  • Joshua Gilbert
  • ALLIANCE MEMBER
  • Manager Utilization Management at Health Alliance Plan (HAP)
  • Jaime Gonzalez
  • ALLIANCE MEMBER
  • Chief Business Development Officer at Health Plan Alliance
  • Stephanie Hass
  • ALLIANCE MEMBER
  • Director of Utilization Management at Paramount Health Care
  • Kelly Kimball
  • ALLIANCE MEMBER
  • Manager Medical Management at Quartz Health Solutions
  • Tina Korty
  • ALLIANCE MEMBER
  • Vice President, Health Plans Legal, Compliance & Regulatory at IU Health Plans
  • Kyle Lieneck
  • ALLIANCE MEMBER
  • Regulatory Affairs Manager at Johns Hopkins Health Plans
  • Charla Lowery
  • ALLIANCE MEMBER
  • Compliance Specialist at Health Alliance Plan (HAP)
  • Bess Ann Mckillop
  • ALLIANCE MEMBER
  • Product Development Supervisor at Physicians Health Plan
  • Vanessa Onacilla
  • ALLIANCE MEMBER
  • Manager, Provider Network Operations at AvMed
  • Nike Otuyelu
  • ALLIANCE MEMBER
  • Chief Compliance Officer at Health Alliance Plan (HAP)
  • Kirit Pindolia
  • ALLIANCE MEMBER
  • Director, Medical Genetics and Genomics at Health Alliance Plan (HAP)
  • Johnathan Randle
  • ALLIANCE MEMBER
  • Dir of Gov't Programs Compliance Officer at Health Alliance Plan (HAP)
  • Dana Renicker
  • ALLIANCE MEMBER
  • Medicare Education Specialist at SummaCare
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Vice President Operations at SummaCare
  • christina salm
  • ALLIANCE MEMBER
  • Vice President of Medical Management Operations at Quartz Health Solutions
  • Janice Sawyer
  • ALLIANCE MEMBER
  • Senior Regulatory Auditor at Health Alliance Plan (HAP)
  • Irina Shikin
  • ALLIANCE MEMBER
  • Sr. Regulatory Auditor at Health Alliance Plan (HAP)
  • Yuri Sung
  • ALLIANCE MEMBER
  • Senior Specialist, Programming at Health Plan Alliance
  • Elaine Taylor
  • ALLIANCE MEMBER
  • Compliance Consultant at IU Health Plans
  • Nancy Weber
  • ALLIANCE MEMBER
  • Clinical Integration Program Manager at Network Health
  • Stephanie Wiegman
  • ALLIANCE MEMBER
  • Customer Experience Coordinator at Samaritan Health Plans
  • Andrea Yap
  • ALLIANCE MEMBER
  • Manager of Financial Controls, Model Audit Rule, ORSA at MediGold
  • Elaine Zettel
  • ALLIANCE MEMBER
  • Lead MA Product Consultant at Health Alliance Plan (HAP)
Speakers