Medicare Advantage (MA) insurers operate in a challenging space within the healthcare system.
Heavy regulations from the federal government create unique requirements for coverage, criteria, customer service, appeals, and outcomes. Star ratings are becoming increasingly important with the benefits of a high star rating being crucial to flourishing in this marketplace.
The team at Cadenza Health has been operating as utilization reviewers in the MA arena for years. We have developed expertise in coverage and medical necessity determinations while understanding the nuances created by oversight from the Centers for Medicare and Medicaid Services (CMS). Each component of the UM process is vital to your organization's star rating. A partnership with Cadenza Health is a 5-star decision.