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The SME Report

Segal Medicare Experts (SME)  –  Industry News and Updates
Written by Shelley Segal and a team of Medicare Advantage Subject Matter Experts


Did you miss the Notice of Intent to Apply (NOIA) deadline for Medicare Advantage Organizations?

The Centers for Medicare & Medicaid Services (CMS) released the 2022 Readiness Checklist with expectations for full compliance in 15 major areas “prior to the 2021 Annual Election Period (AEP) and coverage beginning January 1, 2022.”

CMS Requires Policies & Procedures and Implementation — “A Must”

CMS may at any time request policies and procedures and evidence of

read more

Here’s what you need to know


“Working with Shelley and her team at SME is an amazing experience. I was starting a new company from scratch and Shelley took the time to help me set up an in-depth compliance program for me and my entire team.  She walked me through the entire process, and made sure that I understood what each document was and why it was important. She kept me in the loop from the beginning of the process until the very end. She made it easy for me!”


Ryan C Dodson 
Ryan C Dodson

“I have known Shelley for the past 30+ years, beginning when she was part of my operations and executive team. With her knowledge and expertise in both the regulatory and health plan perspectives, Shelley provides her clients with effective and thoughtful solutions to some of the most complex Medicare Advantage issues facing the industry. I have engaged Shelley and her team on many projects, and my staff greatly appreciate their insights, actionable recommendations and rolling up their sleeves to make things happen I look forward to continuing to work with Segal Medicare Experts in the future! They are really the subject matter experts.”

Michael Myers CEO, Universal Healthcare MSO, LLC DBA Sunrise Wellness Care
Michael Myers


“At my previous employer Brand New Day Health Plan, I used the assistance and auditing experience of Shelley and her team for over 10 years. The Plan selected them year after year to help with audits and projects because the SME team are experts who are timely, professional, flexible, and very helpful in preparing for CMS audits. We liked that they enabled us to learn to meet CMS standards and protocol by helping us to identify where adjustments were needed. SME not only pointed out our weaknesses, but provided us with advice regarding steps we could take to meet our goal of 100% compliance. A big “plus” is that Segal Medicare Experts responds quickly with citations and clarifications, and we could always count on them!”

Connie Snyder Compliance Officer, Renal Payer Solutions, LLC
Connie Snyder



“Shelley and her team are meticulous and well-versed in the Medicare Managed Care industry. I can count on her for timely and accurate results to help navigate complex issues in a variety of areas. She is always there when needed and goes above and beyond to deliver exceptional support and results.”

Dawn Maroney President, Alignment Healthcare
Dawn Maroney

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