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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.

06/19/2026

Today, MHK observes Juneteenth. On this day in 1865, more than two years after the Emancipation Proclamation, the last enslaved people in the United States finally learned they were free. Juneteenth marks that day, a moment of long-delayed justice and a reminder of how much further the work of equity still has to go.

For us in healthcare, that work is ongoing. Building a system where quality care reaches every community, regardless of race or circumstance, remains a goal worth recommitting to today and every day.

Our offices are closed today in observance of Juneteenth, giving our team time to reflect, honor, and celebrate. To everyone marking the day: we wish you a meaningful Juneteenth.

06/15/2026

The new Medicaid work requirement is often framed as a state implementation challenge. For health plans, it's a care continuity challenge.

Finalized by CMS on June 1 and effective in most states by January 1, 2027, the rule layers an 80-hour monthly work requirement on top of more frequent eligibility checks. The likely result: eligible members cycling on and off coverage due to documentation and administrative friction, the exact type of volatility that disrupts care plans and threatens quality performance.

In our latest Strategic Insights post, we unpack what's coming and what it means for care management programs.

Read more: https://hubs.li/Q04lsQKP0

06/12/2026

The MHK team had a great time at the recent MCG Health 2026 Client Forum, connecting with clients, partners, and healthcare leaders from across the industry.

Throughout the event, we explored innovative approaches to healthcare operations, exchanged ideas on emerging technologies, and discussed the growing role of AI in supporting more efficient, informed decision-making.

Throughout the event, we discussed the challenges health plans face today and explored how intelligent automation, interoperability, and AI can help drive greater operational efficiency and improve the member experience.

Pictured (L to R): The MHK usual suspects, Mark Francen and Jamal Jasser.

06/12/2026

AHIP 2026 reminded us of something important: while technology continues to evolve, meaningful conversations remain at the heart of healthcare transformation.

The MHK team spent the week connecting with health plan leaders, discussing operational challenges, exploring new ideas, and sharing perspectives on the future of healthcare technology and the responsible application of AI in healthcare operations.

Thank you to everyone who stopped by to meet with us in Las Vegas. We look forward to building on these conversations in the months ahead.

Shoutout to Conor Bagnell, Jesse Lishchuk, and Mike Fafara for a great week at AHIP 2026, and thanks to Elena Rodin Kombocode for the great conversation.

06/12/2026

CMS just dropped the CY2027 Standardized Materials, and this round isn't a light touch. If you're on the compliance or ops side of a Medicare Advantage, MA-PD, PDP, or Cost plan, here's what's actually changing:

→ A major Part C EOB refresh and modernization
→ Significant Part D benefit language updates
→ D-SNP communication and enrollment changes
→ Removal of the remaining VBID references

Translation: ANOC templates, EOC generation systems, and member materials all need a fresh look before CY2027 production ramps. And if you've built custom deviations from the CMS models over the years, now's the time to confirm none of that removed language is quietly hanging around.

Our latest Compliance Pulse breaks down what plans should be doing right now, area by area:
https://hubs.li/Q04lfZWf0

What's at the top of your CY2027 readiness list?

06/10/2026

In Medicare Advantage, even small discrepancies between enrollment records and CMS payments can have significant financial consequences.

The challenge isn't simply receiving payments. it's ensuring payments accurately reflect member eligibility, risk status, and ongoing changes that occur throughout the year.

MarketProminence helps health plans reconcile enrollment, eligibility, and payment data at the member level, providing greater visibility into expected revenue while helping identify discrepancies before they become larger operational issues.

When financial reconciliation is automated and aligned with member data, organizations gain confidence in forecasting, compliance, and strategic planning.

How much time does your team spend reconciling data across systems today?

06/08/2026

New Medicaid community engagement requirements are a reminder that regulatory changes rarely stop at compliance.

They create new verification processes, new member communications, additional appeals activity, and expanded reporting obligations.

Whether the challenge involves Medicaid eligibility, prior authorization, CMS audits, or quality reporting, health plans continue to face growing operational demands.

How is your organization preparing to manage increasing complexity while maintaining efficiency and member experience?

06/08/2026

🌈 This Pride Month, we celebrate the LGBTQ+ community and the unique perspectives, experiences, and contributions that help make our workplaces and communities stronger.

At MHK, we believe that fostering a culture of belonging isn't just good for our employees—it's essential to building better healthcare experiences for our customers and the members they serve. By creating an environment where people feel respected, valued, and empowered to be themselves, we strengthen our ability to serve the diverse communities that healthcare touches every day.

As part of Hearst Health, we're proud to recognize Pride Month and reaffirm our commitment to inclusion, respect, and health equity for all.

Happy Pride Month. ❤️🧡💛💚💙💜

06/04/2026

For many Medicare Advantage plans, the challenge isn't growth, it's effective management of the operational complexity that accompanies growth.

Enrollment changes. requirements evolve. Billing and reconciliation processes become more demanding. Small discrepancies can create downstream administrative burden, compliance risk, and revenue impacts.

That's why leading health plans rely on MarketProminence.

Purpose-built for Medicare Advantage, MarketProminence helps plans automate enrollment, billing, financial reconciliation, and compliance workflows while maintaining visibility across the member lifecycle.

The result?

Less time spent managing complexity and more time focused on serving members. How is your organization balancing operational efficiency with growing regulatory demands?

06/04/2026

Electronic prior authorization is often discussed as a technology challenge, but many organizations are still struggling with a more fundamental issue: intake.

Requests continue to arrive through multiple channels, in multiple formats, with varying levels of completeness. Before automation, AI, or clinical review can begin, organizations must first identify, validate, route, and manage incoming information efficiently.

In this week's Strategic Insights, we explore why fragmented intake remains one of the biggest obstacles to prior authorization efficiency—and how orchestration strategies can help health plans and PBMs create more connected, transparent workflows.

See link to article in comments.

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3031 N Rocky Point Drive W, 300
Tampa, FL
33607

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Monday 9am - 5pm
Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm
Friday 9am - 5pm