In the Midst of AEP…Don’t Lose Sight of the Upcoming Application Season Compliance Solutions

In mid-October, CMS will release the online Calendar Year 2021 Notice of Intent to Apply (NOIA).  The NOIA must be submitted to CMS by November 12, 2019 if organizations plan to submit an application for the 2021 plan year, either for a new contract or contract expansion, including the following:

It’s that time again…time to begin marketing for the upcoming plan year and prepare for sales and enrollment activities during the Annual Election Period (AEP).  With all that entails, it can be easy to forget about other upcoming important dates on the Centers for Medicare and Medicaid Services (CMS) calendar.

  • New Medicare Advantage (MA) or Prescription Drug Benefit (Part D) contract
  • Offering a new product type
  • Expanding the service area
  • Adding prescription drug benefits (Part D) to an existing contract

How can organizations be best prepared?  It’s not too late to conduct a feasibility study to assist in the ‘go/no-go’ decision.  A network analysis should also be completed to determine any potential adequacy issues or gaps.  Remember that filing the NOIA with CMS only informs them of the Organization’s intent to apply, it does not require that a formal application be submitted.

Gorman Health Group can assist in all phases of the application process including the feasibility study, network analysis, and application completion/submission.  We have a long history of successful submissions and support.  Contact us today to discuss how we can best support your Organization.

GHG cannot only assist with your application filing but can also project manage the entire process?  Contact us today for more information.

Tina Bailey
Tina Bailey

Vice President, Compliance Solutions

Tina Bailey began her tenure at GHG in 2011 and was appointed Vice President, Compliance Solutions in August 2018. In this capacity Tina leads the Compliance Solutions team and its engagements to ensure optimum solutions. Tina brings GHG clients more than 25 years of experience, providing them a knowledgeable resource in Medicare Advantage and Part D with an emphasis on Special Needs Plans (SNPs). Her areas of expertise include compliance, applications, audits, readiness, delegation oversight, marketing materials, bid development, new plan implementation as well as appeal and grievance expertise. Prior to her role at GHG, Tina held a management position with a SNP where she was responsible for the organization's day-to-day Medicare operational compliance. Tina has also held management positions with several MAOs in the greater Los Angeles and Orange County markets. In her previous roles, Tina was responsible for compliance interpretation and implementation, member/marketing material review and submission, bid development and submission, internal audits and CMS audit preparation, implementing internal corrective action plans, and creating detailed trainings. Tina is certified in Compliance and Ethics from the Health Care Compliance Association.

No Comments Yet

Leave a Reply

Your email address will not be published.