The 5 Hidden Costs of Ghost Networks
Effective cost management is paramount for healthcare organizations, yet the issue of ghost providers remains a significant contributor to avoidable expenses. Through an analysis of the financial implications associated with ghost providers, you can identify and mitigate costs across five critical areas. Download Article Defining Ghost Networks A ghost network refers to healthcare providers listed […]
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 while intensifying oversight. These changes have far-reaching implications for medical and ancillary plans. Understanding the key developments and emerging trends is essential for stakeholders to ensure strategic alignment and maintain compliance. Get the Executive Summary Medicare Advantage Medicare […]
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 […]
Medicare Advantage: Latest Network Adequacy Application Insights
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. Overview of Network Adequacy Changes for […]
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 […]
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 […]
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 transform your workflow with unparalleled visibility. We are excited to unveil new features designed to enhance your understanding of network adequacy risks, analyze network exposure, and empower you to act strategically. Enterprise Compliance Dashboard: Pinpoint Network Adequacy With the Quest Enterprise Services Enterprise Compliance Dashboard, […]
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 […]
Quest Analytics Launches Provider Claims Insights Integrated into Quest Enterprise Services
Quest Analytics, the leader in provider network management solutions and services, today announced the launch of Provider Claims Insights. This new offering adds provider performance measures within the Quest Enterprise ServicesTM (QESTM) platform to help health plans improve provider selection and overall network performance. Quest Enterprise Services Provider Claims Insights gives network teams the tools […]
