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MHK Enterprise Software Platform for Medicare, Medicaid, and Exchanges

MedHOK solutions improve clinical outcomes, care management and quality measures, and links reimbursement to improved quality outcomes for accountable care organizations, patient centered medical homes, health plans, public sector agencies, providers, hospital systems and third party administrators.

10/08/2026

CMS-0062-P could change how health plans manage drug prior authorization. Are your workflows ready?

The proposed rule goes beyond electronic transactions and raises important questions about how health plans manage documentation, clinical review, decision-making, and communication across medical and pharmacy operations.

In this week's Strategic Insights article, we examine five operational areas health plans should be evaluating now—and why preparation involves more than technology alone.

Read the article: https://hubs.li/Q04zFzc80

09/30/2026

Congratulations to Blue Cross Blue Shield of Massachusetts on earning a 5-star rating in NCQA’s 2026 Health Plan Ratings.

NCQA’s annual ratings recognize health plans for performance across measures of clinical quality and member experience, including HEDIS® and CAHPS® measures.

MHK is proud to work with Blue Cross Blue Shield of Massachusetts and to recognize the commitment to quality reflected in this achievement.

09/28/2026

With CMS-0062-P, CMS has set its sights on another major component of prior authorization: prescription drugs. The rule proposes expanding electronic prior authorization requirements to drugs, building on the interoperability efforts already underway through CMS-0057-F.

While not yet final, the rule provides health plans with an early look at where electronic drug prior authorization may be heading, and an opportunity to begin evaluating readiness.

Our latest blog explores what CMS-0062-P proposes, how it relates to CMS-0057-F, and what health plans should be considering now.
Read the full article: CMS-0062-P: Electronic Drug Prior Authorization | MHK (https://hubs.li/Q04ys2hM0)

CMS has released updated CY 2027 Medicare Advantage and Part D enrollment and disenrollment guidance, bringing changes t...
09/25/2026

CMS has released updated CY 2027 Medicare Advantage and Part D enrollment and disenrollment guidance, bringing changes that health plans should begin preparing for now.

The guidance includes updates to election periods, enrollment capacity, passive enrollment, model notices, website access requirements, and D-SNP eligibility and deeming processes. CMS also issued an important correction to the Special Enrollment Period (SEP) timing associated with certain plan terminations or modifications. With the updated guidance taking effect January 1, 2027, plans should begin reviewing enrollment workflows, member communications, system logic, training, and documentation to help support operational readiness.

Read the latest MHK Compliance Pulse for a breakdown of the changes and key considerations for health plans: https://hubs.li/Q04ykBGq0

09/24/2026

Congratulations to UPMC Health Plan on earning a 5-star rating in NCQA’s 2026 Health Plan Ratings.

NCQA’s annual ratings recognize health plans for performance across measures of clinical quality and member experience, including HEDIS® and CAHPS® measures.

MHK is proud to work with UPMC and to recognize the commitment to quality reflected in this achievement.

Is your organization ready for the Prior Authorization API, or just the API itself? As the January 1, 2027, CMS-0057-F d...
09/23/2026

Is your organization ready for the Prior Authorization API, or just the API itself? As the January 1, 2027, CMS-0057-F deadline approaches, health plans are focused on interoperability and meeting the technical requirements. But what happens after a prior authorization request enters your organization?

Connecting systems doesn't automatically eliminate manual work, fragmented processes, or operational bottlenecks. True readiness means looking beyond the API to the workflows, automation, and orchestration needed to turn greater interoperability into greater efficiency.

Our latest Strategic Insights explores why preparing for CMS-0057-F requires thinking beyond the connection.

Read more: https://hubs.li/Q04y8cp60

09/22/2026

MHK is heading to AMCP Nexus 2026!

Join us October 26–29 in San Diego and discover how MHK is helping health plans put AI to work—bringing intelligent automation to complex workflows to help teams work more efficiently and make informed decisions faster.

Visit Booth 411 to meet the MHK team, explore our solutions, and see how we’re bringing practical AI to health plan operations.

We look forward to seeing you in San Diego!

January 1, 2027, is an important CMS-0057-F milestone. But meeting the deadline is only part of the opportunity. In prep...
09/16/2026

January 1, 2027, is an important CMS-0057-F milestone. But meeting the deadline is only part of the opportunity. In preparing for the next phase of CMS interoperability and prior authorization requirements, the bigger question for health plans is: what happens around the API?

That’s where interoperability, automation, and orchestration unite. Interoperability can make information available, automation can reduce repetitive work, and orchestration can connect the steps into a process that moves more efficiently from request to decision.

Our latest Strategic Insights looks at what’s already in effect, what’s coming in 2027, and why health plans should begin thinking beyond technical readiness to the workflows that surround it.

Read more: https://hubs.li/Q04xHxZK0

09/14/2026

The performance bar is moving for plans. Preliminary 2027 Medicare data shows that approximately half of the cut points have become harder to reach. For health plans, that means maintaining last year’s performance may not be sufficient to maintain the same Star Rating on individual measures.

As thresholds shift, understanding where performance is changing, and acting on quality opportunities early, becomes increasingly important. In this week’s Strategic Insights, we look at what the changing 2027 cut points mean for health plans and why a more proactive approach to quality performance matters.

🔗 Read the full article: https://hubs.li/Q04xty-x0

We’re excited to announce a new certified integration between MHK and MCG Health designed to help health plans streamlin...
09/10/2026

We’re excited to announce a new certified integration between MHK and MCG Health designed to help health plans streamline prior authorization and advance interoperability readiness. The integration connects MCG Path directly with MHK CareProminence, bringing trusted, evidence-based clinical guidance and documentation requirements into the prior authorization workflow. By supporting HL7® Da Vinci Project standards including CRD, DTR, and PAS, the integration can help health plans:

• Reduce administrative burden
• Support more consistent, evidence-based decisions
• Identify required clinical documentation earlier in the process
• Prepare for CMS-0057-F interoperability requirements

It’s another step toward making prior authorization more connected, efficient, and easier to navigate for health plans and providers and to help members get the right care.

👉 Read the announcement: https://hubs.li/Q04xbFH10

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