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 […]
The 5 Hidden Costs of Ghost Networks
Managing costs is critical for healthcare organizations aiming to maintain fiscal health and operational efficiency. Among the myriad of cost-related challenges, ghost providers represent a significant yet often overlooked financial drain. By examining the financial implications of maintaining ghost providers, we can identify avoidable costs across five key areas: inefficiency in resource allocation, unnecessary administrative […]
Health Policy Trends Across Markets
Health policy is a dynamic field, continually evolving to improve the healthcare industry. As regulators and stakeholders push for higher standards, several key trends are emerging across markets that aim to enhance the efficiency, transparency, and equity of healthcare delivery. Significant policy trends observed in various markets include a focus on provider verification timelines, data […]
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 Proposed Payment 2026, […]
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 […]
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 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 […]