CMS Medicare Advantage and Medicaid 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.
New Network Adequacy Requirements CY2025 Medicare Advantage Policy Brief

Policy Brief: CY2025 Medicare Advantage Final Rule

Get Ahead: 2025 CMS Medicare Advantage Insights. New Network Adequacy Requirements explained. Download our policy brief today.

Triennial Network Adequacy Review Essentials for Medicare Advantage Organizations
Compliance serves as a hallmark of integrity and a complex challenge for contemporary businesses. It’s an indispensable aspect of corporate governance that keeps companies in good standing with regulatory bodies...
Everything to Know About Behavioral Health Policies in Medicare Advantage
Recognizing mental health as a key component of overall wellness is not just a change in societal attitudes but also a critical factor in improving healthcare delivery. The Centers for...
Understanding Medicare Advantage Network Adequacy Requirements
If you’re in the world of Medicare Advantage, you likely know how crucial it is to stay on top of CMS updates. The Contract Year 2025 Medicare Advantage and Part...
CMS Medicare Advantage Network Adequacy Submission
Supercharge Your Medicare Advantage Network Submission Best Practices for Submitting HSD Tables to CMS Are you feeling the heat from the Centers for Medicare & Medicaid Services (CMS) when it...
Medicare Advantage Network Adequacy and Provider Data Accuracy Toolkit
CMS Medicare Advantage Network Adequacy and Provider Data Accuracy Audit Toolkit Ensure Your Medicare Advantage Network Passes with Flying Colors Want to make sure your Medicare Advantage plan is compliant?...
CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations
If you’re involved with compliance, market expansion, or provider recruitment for a Medicare Advantage (MA) Organization, listen up! As organizations seek to either enter the Medicare Advantage market or expand...
Frequently Asked Questions & Answers: Medicare Advantage Applications and Letters of Intent
Medicare Advantage Organizations applying for initial, or service area expansion can use Letters of Intent in place of a signed contract to help meet network adequacy requirements while going through...
CMS Corrective Action Plans: What Medicare Advantage Organizations Need to Know
The Centers for Medicare & Medicaid Services (CMS) turned things up a notch with new provider directory requirements last year, and now they’re doubling down with Corrective Action Plan requests...
CMS Exception Request to Network Adequacy Criteria Checklist
Create a Compelling Case for Your Exception Request The time has come–you need to make a network adequacy exception request. Nobody wants to fall into a regulatory pothole, so a...
Health Policy News Discover the latest federal and state network adequacy and provider directory accuracy policy developments. Read the blog now!

NETWORK ADEQUACY AND PROVIDER DIRECTORY ACCURACY POLICY UPDATES

Just in: Network adequacy and provider directory policy updates! Stay in the know with our comprehensive update on the changes that emerged between December ’23 and February ’24. Don’t let these updates catch you off guard – read the article now.

Ghost Networks

Ghost Networks in Healthcare: What They Are and How To Address Them
Ghost networks—ever heard of them? Maybe you’ve come across the term or spotted it in a headline. As they gain more attention, we thought it would be appropriate to give...
How Ghost Networks Impact Health Plans and Health Systems
As a health plan or health system, you want to provide the best possible care for your patients. Unfortunately, ghost providers can make this goal difficult to achieve. These non-active...
The Requiring Enhanced & Accurate Lists of Health Providers Act
Are enrollees receiving the healthcare services they were promised? Inaccurate provider directories and ghost networks have been longstanding concerns in the healthcare industry, particularly with mental health services. Recognizing the need...

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.

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.

Find More Videos from Quest Analytics

Learn the latest news, insights, and strategies, from the experts at Quest Analytics. Explore our collection of provider network management videos on our YouTube channel. 

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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.

Provider Data Management Tips & Resources

8 Data Tips for Medicare Advantage Network Adequacy Reviews
Your provider network is your greatest strength, but a network with inaccurate data or ghost providers isn’t very efficient. Whether you’re fine-tuning your data for a Triennial Network Adequacy Review,...
Why Enterprise Provider Network Management is Important for Health Plans
Times are changing my friend. As someone in the world of provider network management, you know this better than most. From increasing turnover rates on all fronts to ever-morphing work...
The Secret to Provider Data Management Success: Daily Tracking and Measuring
Provider information changes all the time, and if you’re not keeping up with those changes, you could miss out and be at risk of non-compliance. With 20% of providers shaking...
Creating an Effective Provider Data Management Strategy
It is Friday afternoon, and all you can think about is getting out on the green tomorrow at the top-notch golf course everyone talks about. The only problem is scoring...
How Dynamic Provider Network Reports and Analytics Deliver Insights Straight to the Top
In a constantly evolving provider network environment, you need timely and current data to guide your decision-making and strategic planning processes. Manually sorting through large datasets is complex, time-consuming, and...
Teamwork Over Silos: How to Improve Your Provider Data Management
Whether you’re navigating compliance, forging new networks, or skyrocketing sales, one thing’s crystal clear—future success lies in internal alignment and communication. Let’s look at how breaking down silos within your...
The Impact of Provider Data Accuracy on Network Adequacy
The Impact of Provider Data Accuracy on Network Adequacy Download Now! Revealing the Powerful Link between Provider Data Accuracy and Network Adequacy Managing a health plan provider network is like...
5 Best Practices: Improving Provider Data Accuracy, Provider Outreach and Outcomes
Everyone’s buzzing about improving provider data accuracy and transparency these days—and for good reason. Just like an athlete training to reach peak performance, healthcare professionals like yourself need the right...
Provider Outreach and Verification
A Proven Approach to Provider Data Accuracy Download Now! Simplify Provider Data Verification with Attester-Driven Rolling 90-Day Outreach Are you a health plan professional striving to improve your provider verification...
How Network Adequacy Depends On Provider Data Accuracy
Let’s address the elephant in the room – the separation of network adequacy and provider data accuracy. We all know they’re both crucial for a successful provider network. Yet they’re...
Key Metrics for Provider Directory Audits: Provider Outreach Analytics
If you want to pass a provider directory audit, looking at your provider outreach analytics is a great place to start. With the right analytics, you can demonstrate compliance and...
How to Increase Practitioner Response Rates for Data Accuracy
Identifying effective strategies to engage healthcare practitioners is crucial for insurers and decision-makers. By improving response rates from practitioners, you can gather valuable insights and enhance your decision-making processes. In...
Understanding CMS Exception Requests for Network Adequacy
Raise your hand if you’ve ever had difficulties meeting network adequacy criteria. Well, you’re not alone. Submitting an exception request for network adequacy involves multiple components, and we’re here to...

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.

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!

Success Stories

Building Their Own HMO
Wanting to set up their own HMO, they needed to build a county-wide Medicare Advantage network — with no previous experience managing CMS network adequacy requirements
A Tale of Two Networks
Having struggled to build a Medicaid network, they now faced the more complex requirements of Medicare — with only one shot to get it right.
The ROI Of Provider Network Management
On-Demand Webinar The ROI of Provider Network Management Quest Enterprise Services provides a positive ROI for Provider Network Management Hear how a New York health plan uses Quest Enterprise Services...

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.

Schedule Now
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