LATEST INDUSTRY UPDATES |May, 2022
The DOL is now auditing mental health parity compliance. Are you ready?

Webinar replay: Mental health parity compliance and oversight
Are you ready to respond to a mental health parity audit notice in just 14 days? Watch the webinar to learn about NQTL requirements, creating a detailed analysis and managing ongoing compliance/oversight.
Review your YTD risk adjustment program performance for prospective interventions
In late May, there’s often a sufficient sample size to evaluate prospective program performance—and there’s still time to make adjustments for a successful outcome. Read on for five leading indicators to help evaluate 2022 prospective intervention performance.
The rules require most health plans and insurance issuers to publish machine-readable files disclosing in-network rates for covered items and services, out-of-network allowed amounts, and billed charges for covered items and services. Read more here.
Latest from CMS: Continuation of prescription drug event reports and analysis reporting initiatives for 2022 benefit year
In Medicare Part D, correct payment is dependent on the accuracy of the prescription drug event data submitted by Part D sponsors. CMS strongly encourages sponsors to take an active and consistent approach to ensure accuracy of submitted PDE data and resolving errors that lead to PDE rejections. Read full article.
OIG report: Medicare Advantage organization denials of prior authorization requests raise concerns about access to medically necessary care
A recent report by the Office of Inspector General found that some Medicare Advantage organizations delayed or denied beneficiaries’ access to services, even though the requests met Medicare coverage rules. Full article here.
CMS guidance for ACA Plans: Provider directory compliance and network adequacy machine-readable standards
CMS conducts annual reviews to determine whether issuers comply with network adequacy machine-readable standards. Standards require federally-facilitated exchanges to make available and submit provider directory information in an HHS-specified format. Get article here.
Prior authorization process evolve to more streamlined and automated experience
As the emphasis on value-based care continues, frustration voiced by providers about prior-authorization processes has gained attention and traction. Provider concerns include delays in implementing solutions regarding processing delays, quality of care and the substantial administrative burden. Regulators have stepped in to help solve the concerns. Check out full article.