How Ghost Networks Impact Health Plans and Health Systems
Health plans and health systems face significant financial challenges due to the presence of ghost providers. Keeping these providers in your data undermines the efficacy of health systems, resulting in both direct and indirect financial implications. Understanding the hidden costs and addressing them is paramount for maintaining operational excellence and financial stability. 5 Ways Ghost […]
CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations
The Centers for Medicare & Medicaid Services (CMS) unveiled changes to the network adequacy application process for Medicare Advantage (MA) organizations. Whether you’re involved in compliance, market expansion, provider recruitment, or network management, these updates are crucial. Let’s break down these changes to help you understand the new process. CMS Network Adequacy Reviews for Initial […]
QHP Certification and Network Adequacy Review Timeline
Who doesn’t love a good calendar? We know we do. Whether you’re deep into network adequacy updates or juggling deadlines left and right, we’ve got your back. Our handy calendar lays out the crucial submission dates for Qualified Health Plan (QHP) issuers on Federally-facilitated Exchanges. As a bonus, we’ll keep it updated for you! Go ahead and […]
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 guide you through the process. What is Network Adequacy? Before jumping into exception requests, let’s go over some basics. Medicare Advantage Organizations (MAOs) must comply […]
Network Adequacy and Provider Directory Accuracy Policy Updates
Federal and state regulators, along with lawmakers, are actively amending network adequacy and provider directory accuracy requirements. These changes have far-reaching implications for plans and insurers. Understanding the key developments and emerging trends is essential for stakeholders to ensure strategic alignment and maintain compliance. Get the Executive Summary What to Watch CMS Directory Pilot Proposed […]
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 for Medicare Advantage (MA) Organizations that aren’t playing by the rules. We’re breaking down the latest news about the added provider directory requirements and Corrective […]
FAQs: 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 the application process. The intention is to give applicants seeking to expand into a new market the opportunity to reach the threshold for network adequacy […]
Efficiency on Autopilot: Volume Provider Network Reports and Analytics
What do you think of when you hear the word “report”? Maybe it’s your 5th-grade book report that you poured your heart into. Or perhaps it’s the infamous TPS reports from the movie Office Space. Reports, in general, are not typically associated with excitement. However, within the realm of provider network management, reports are indispensable […]
Explore the Latest Features in Quest Enterprise Services for Network Adequacy Compliance
Get ready to level up your provider network analysis and revolutionize your workflow with enhanced visibility. We are thrilled to introduce our latest features, carefully crafted to enhance your understanding of network adequacy risks, realize network exposure, and be able to act strategically. Let’s dive into what’s coming your way. Enterprise Compliance Dashboard: Pinpoint Network […]
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 environments and increasing oversight, it’s been a wild ride and one that shows no sign of slowing down. Amidst this whirlwind, a new expectation has […]
