Medicare Advantage Resources: Legislative Brief

MEDICARE ADVANTAGE PLANS MUST DEMONSTRATE A COMPLIANT NETWORK AT APPLICATION

 New Rules, No Problem

The Medicare Advantage Final Rule changed the way Medicare Advantage Organizations apply for Initial or Service Area Expansion applications. James Lamb, VP of National Payers, is here to shares the 4 key things to you need to know before you apply.

 

The State of Provider Network Oversight

To get a sense of what’s on the horizon for Medicare Advantage Organizations, we need to look at the entire healthcare policy landscape—and then plan accordingly. Scott Westover and Michael Adelberg shed light on the additional factors that CMS considers when addressing Medicare Advantage oversight.

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!

Regulatory Review of the Medicare Advantage Final Rule

CMS reinstates network adequacy reviews as a condition of initial or expanding service area applications. Our own Zach Snyder breaks down the changes to give you astonishing clarity on what’s new.

Build a Best-in-Class Provider Data Management Strategy

Health plans need to create scalable environments in order to remain competitive. With the right strategy and tools, they can improve data workflow across their organization, avoid data silos & bottlenecks, and grow their provider networks efficiently. Here are the five key factors successful health plans use to improve their process for provider data integration, provider network management, and data quality assurance.

On-Demand Webinar

UNDERSTANDING THE NETWORK ADEQUACY CHANGES IN THE MA FINAL RULE

Join Scott Westover and Michael Adelberg for a special presentation on the new Medicare Advantage Application requirements and how you can stay ahead of the curve.

AHIP Webinar Understanding the Network Adequacy Changes in the MA Final Rule

Latest Article

The Hottest Trends Across Health Insurance Markets

Top Trends Across Health Insurance Markets August 2022

The data is in—and it’s clear: provider network oversight, provider data accuracy and provider data transparency are the hot trends across all health insurance markets.

But what does this mean for you? Here’s the inside scoop on what’s going on in the industry right now, what changes are coming down the pike and how to maximize your chances of success.

CMS Changes Network Adequacy Application Process for Medicare Advantage

The Centers for Medicare and Medicaid Services (CMS) is tightening network adequacy oversight again—this time for Medicare Advantage organizations. If you’re involved with compliance, market expansion or provider recruitment, we’ve broken down how the change impacts you.

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.

Expand Your Footprint

When it comes to your expansion, you need tools that make it easier and faster for you to make the right decisions. You want to know which providers can add the most value to your network and where to focus your efforts for the most gain. Quest Enterprise Services helps you do just that!

Provider Data Management Tips for CMS Compliance
Network Adequacy Applications, Submissions, Reviews and More
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Planning Worksheet

CMS Network Adequacy Review
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Best Practices Infographic

Maintain Adequate & Accurate Networks
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Best Practices Infographic

How to Manage Your Provider NPI Data
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Handy Calendar

Key CMS Medicare Advantage Dates
CMS Medicare Advantage network adequacy submission information downloadable.

Best Practices Infographic

Steps to Take for a Successful Network Submission
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Guide

How to Establish Effective Compliance Monitoring
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Smart Stats Infographic

How Inaccurate Provider Data Impacts Network Adequacy
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White Paper

Provider Directory Accuracy Key Element of Network Adequacy
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Tricks of the Trade Infographic

Keep Your Provider Data in Tip-Top Shape

Stay Compliant-Confident Year-Round

Network Adequacy Templates

Quest Analytics has pre-built templates based on the current Federal standards & requirements for Medicare Advantage and Medicare-Medicaid, as well as an ever-growing list of state programs. See which templates are available for you today! 

Solutions for Provider Data Management Network Adequacy Templates

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 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.

Strategies for Success

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.

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.

Start Today

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 Analytics expert today.

Book a Strategy Session

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