Turning chaos into clarity: achieving financial accuracy in MAPD reconciliation

With new CMS rules and shifting risk models, even small mistakes can result in millions lost or expose your plan to costly penalties.

As Medicare Advantage Prescription Drug (MAPD) plans evolve, health plans face greater complexity in revenue reconciliation. New CMS regulations, updated risk adjustment models, and increased payment integrity scrutiny are raising the stakes—manual processes simply won't keep up. Forward-looking organizations are leveraging technology and automation to ensure accuracy, compliance, and audit readiness.

This comprehensive guide offers a blueprint for mastering compliance, preventing revenue leakage, and staying audit-ready in 2025 and beyond.

What you'll learn:

• How MAPD revenue reconciliation has evolved and what it means for your health plan
• The impact of new CMS regulations, risk adjustment model changes, and payment updates
• The critical role of data integrity and advanced technology in ensuring financial accuracy
• Strategies to automate and streamline reconciliation processes, reducing manual effort and errors