CMS Resource Hub

Medicare Advantage & Medicaid Resources

We’re covering all key topics related to the Centers for Medicare & Medicaid Services (CMS): Network Adequacy Applications, HSD Tables, Triennial Reviews, Service Area Expansion, Star Ratings and more! Below you’ll find our growing collection of guides, videos and tools to help you achieve your Medicare Advantage Part C & D, Medicare-Medicaid and QHP goals.

CMS Extends Contract With Quest Analytics

Press Release

CMS Extends Its Contract With Quest Analytics

The Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, facility and pharmacy networks.

On-Demand Webinar

The ROI of Provider Network Management

Hear how a New York health plan uses Quest Enterprise Services to quickly and efficiently identify the right providers to fill gaps, leverage deeper data insights to optimize contract negotiations with providers, improve internal communication, and streamline the process for submitting HSD Exception Requests.

Strategies for Success

What To Do When Your Medicare Advantage Contract Is At Risk

Discovering network deficiencies after submitting your HSD table to CMS can be stressful. Where should you start if you want to quickly add providers to the network? Eliza Hoffman, our VP of Regional Payers Segment, shares the answer.

Network Adequacy Applications, Submissions, Reviews, and More

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CMS Calendar

Key Medicare Advantage Dates for 2021 and 2022

CMS Medicare Advantage network adequacy submission information downloadable.

Infographic

Steps to Take for a Successful Network Submission

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Guide

How to Establish Effective Compliance Monitoring

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Infographic

How Inaccurate Provider Data Impacts Network Adequacy

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White Paper

Provider Directory Accuracy is an integral part of network adequacy

How to prepare your provider directory information downloadable.

Infographic

Best Practices: Steps to Take to Prepare Your Provider Directory

Federally Facilitated Market Qualified Health Plans

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Blog Post

CMS to Regulate Qualified Health Plan (QHP) Network Adequacy

Federal Court Vacates 2019 Rule on Federal Review of Network Adequacy

Legislative Brief

Court Vacates 2019 Payment Notice on Federal Review of Network Adequacy

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Legislative Brief

HHS Notice of Benefit and Payment Parameters for 2022 Second Final Rule

Medicare Advantage Star Ratings

CMS Star Ratings: Five Things to Know About the Changes

NEXT STEPS

Schedule Your Complimentary Assessment

Interested in discovering how we can assist you with your service area expansion and network adequacy goals? The best way to move forward is by scheduling a complimentary assessment in which our team will show you both the areas that are best for expansion as well as identify high-risk providers within your data including, but not limited to:
• Deactivated NPIs
• Invalid NPIs
• Missing NPIs
• Medicare Opt-Out NPIs
• OIG NPIs
• Providers with excessive practice locations
• Providers with suspect specialty combinations

Get started by scheduling your complimentary session with a Quest Analytics team member today.

Book a Strategy Session

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