Operations

BluePeak Advisors can provide health plans and pharmacy benefit managers assistance with Part C and D Medicare operations remediation and efficiencies. We can analyze your processes and provide practical solutions and operational best practices to meet Medicare standards in all areas including coverage determinations, organizational determinations, appeals, grievances, formulary, call center, medication therapy management, claims, vendor management, provider contracting, SNP Model of Care, utilization management, enrollment, finance, marketing and sales. Read more

Compliance

BluePeak will prepare health plans and PBMs for CMS Program audits by performing mock CMS audits utilizing CMS protocols, reviewing operational area universes for compliance, supporting your teams during the actual CMS audits, assisting with writing corrective action plans and providing validation audits before CMS returns. We will coach and teach plans how to perform their own mock audits and how to review cases with CMS during actual audits. BluePeak can review and rewrite policies and procedures across all operational areas. We understand both the compliance and operations Read more

Strategy

Medicare, the Exchanges and other government programs are evolving on a daily basis. BluePeak can provide health plans, Employer Group Waiver Plans (EGWPs) and PBMs strategic direction for product development and expansion both from a business growth perspective as well as from an internal support need. Pharmaceutical manufacturers and other allied health product companies will benefit from specific market segment knowledge, experience and direction in order to expand their business, build new products and succeed in the ever changing health care market.

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