Medicare Advantage Resource Hub

Discover the latest insights and proven provider data management tips for CMS compliance. Our expanding collection of resources is here to help you achieve your Medicare Advantage and Medicare-Medicaid Plan goals.

Ace Your Medicare Advantage Application

Happy Network Submission Season Medicare Advantage Organizations! Dive into our handy resources for expert advice, insider tips, and top strategies to ace your initial or service area expansion application. 

Frequently Asked Questions about How to Use Letters of Intent for a Medicare Advantage Application

Frequently Asked Questions & Answers: Medicare Advantage Applications and Letters of Intent

Discover the ins and outs of using Letters of Intent in the Medicare Advantage application process. Read our comprehensive FAQs blog to get your questions answered about who, how, what, and when.

Medicare Advantage Applications and Letters of Intent: Process and Timelines Explained

Wondering when and how to submit Letters of Intent during your Initial or Service Area Expansion application? Roxanne Butts, Client Services Consultant at Quest Analytics, walks you through the operational instructions and submission timelines.

CMS Changes Network Adequacy Application Process for Medicare Advantage

CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations

Stay up to date with the latest CMS changes on the network adequacy application process for Medicare Advantage Organizations. Read our article to learn key insights and best practices.

Medicare Advantage Applications: Using Credits and Letters of Intent

Scott Westover, SVP of Network and Regulatory Strategy at Quest Analytics, explains what the two allowances Application Credit and Letters of Intent mean for Medicare Advantage Organizations applying for an initial or service area expansion contract 

Conquer the Essentials 2024 Medicare Advantage Final Rule Brief: A CMS Compliance Guide

Policy Brief: Network Adequacy Requirements

Discover the latest updates in behavioral health specialties and let us guide you through its implications for your provider network. Download our policy brief to learn about the updated Network Adequacy and Provider Directory Accuracy requirements. 

Now Available the Medicare Advantage Proposed Rule Executive Summary by Quest Analytics

Get the scoop on Medicare Advantage Program Proposed Changes for Contract Year 2025

Wondering what’s in store for the Medicare Advantage Program in Contract Year 2025? We’ve got all the details you need to know about possible network adequacy and provider directory accuracy changes. Download our Executive Summary for a quick overview.

Understand the Requiring Enhanced & Accurate Lists of Health Providers Act

There’s a new proposed policy dedicated to eliminating ghost networks and enhancing provider data accuracy within Medicare Advantage provider directories. Read our article today to learn more. 

What to Watch: Network Adequacy and Provider Directory Accuracy Trends - November 2023

What's Happening in the World of Health Policies?

Keep up with the network adequacy and provider directory accuracy policy developments. Our experts are here to give you the rundown on what’s making moves at the federal and state levels. Read the article now. 

Take a Medicare Advantage Network Adequacy Assessment

Discover the insights you need to strengthen your network adequacy and accuracy in Medicare Advantage provider network management. Get your Action Plan Accelerator today and empower your team for confident, review-ready compliance monitoring processes!

WHAT TO DO WHEN YOUR MEDICARE ADVANTAGE CONTRACT IS IN JEOPARDY

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.

breaking silos, leveraging efficiencies and reducing risk

Seeking scalability and visibility across all of Molina’s networks, one of their new SVPs started putting a plan in motion that has led to greater compliance confidence, consistent reporting and faster speed to market.

Join us as we learn what it takes to break down organizational silos and what you can expect to gain as the reward.

Speakers:

Karen Decaran-Voigt, SVP of National Networks, Molina Healthcare

James Lamb, VP of National Payers, Quest Analytics

Streamline Your Network Adequacy Exceptions

EXPEDITE YOUR PROCESS. ENHANCE YOUR EXCEPTION NARRATIVE.

Getting a network adequacy exception request accepted is no walk in the park. This can be true whether you’re submitting to the Centers for Medicare & Medicaid Services (CMS) or a State Regulator. The Quest Enterprise ServicesTM Exceptions Package automates and simplifies your network adequacy exception request process for CMS or the State, leaving you with more time to focus on other priorities. Discover how one health plan uses the Quest Enterprise Services Exceptions Package to reduce, expedite and enhance their network exception requests.

Ensure Provider Data Accuracy Compliance and Optimal Outcomes - Read the Blog Post Regular Data Management Keeps Members and Regulators Happy

REGULAR DATA MANAGEMENT KEEPS MEMBERS AND REGULATORS HAPPY

As provider network submissions become more stringent, it is important to prioritize critical areas of provider data management. We have some insider tips that will help you meet minimum requirements and exceed expectations. Read the article to learn about these tips.

Provider Data Management Tips for CMS Compliance

Network Adequacy Applications, Submissions, Reviews and More

Discover Your Opportunity, Network Build and ROI

When you’re preparing to expand your Medicare Advantage Provider Network footprint, it’s important to understand the costs and potential ROI of adding new counties. In this video, Eliza Hoffman, VP of Regional Payers, shares how she and her team can help you understand the network build effort to expand into each desired county, the potential ROI upon achieving average enrollment, and which providers to contract with to quickly and efficiently fill specialty gaps. Schedule your Complimentary Opportunity Analysis today!

WHY KNOWING WHICH PROVIDERS ARE LISTED AT MULTIPLE LOCATIONS IS CRUCIAL TO CMS COMPLIANCE

Paula Partin, our Senior Director of Quest Enterprise Services Adequacy, reminds us why knowing which providers are listed at multiple locations—sooner rather than later—is key to avoiding costly errors.

How Provider Network Management Teams Position Themselves for Success

As health plans evolve to keep pace with today’s ever-changing requirements, Provider Network Management teams must adapt their data management strategies to support provider data accuracy, transparency, and automation. Eliza Hoffman, VP of Regional Payers, shares our top strategies for maintaining a thriving – and compliant provider network.

MEASURE YOUR NETWORK LIKE CMS

Ready to evaluate your provider network the same way that regulators will evaluate it? Quest Analytics delivers the answers to your test – bringing peace of mind by showing you what regulators will see when they evaluate your network. Our Medicare Advantage and Medicare-Medicaid Network Adequacy templates will reduce your compliance testing time and cost, leaving you with more time to focus on getting better insight into your data and taking action where it matters.

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.

SCHEDULE YOUR COMPLIMENTARY NETWORK ASSESSMENT

Interested in discovering how we can assist you with your service area expansion and network adequacy goals? Schedule your complimentary network assessment with a Quest AnalyticsTM expert today.

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