Understanding CMS Exception Requests for Network Adequacy

CMS Exception Requests to Network Adequacy Criteria Explained by Quest Analytics

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 […]

How Ghost Networks Impact Health Plans and Health Systems

5 Ways Ghost Networks Cost You: 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 providers can harm both patients and your business in numerous ways. Here are five ways ghost networks can cost you, from disrupting access to patient […]

Network Adequacy and Provider Directory Accuracy Policy Updates

Health Policy News Discover the latest federal and state network adequacy and provider directory accuracy policy developments. Read the blog now!

Now that 2024 is fully underway, we’d like to bring you up to speed on the network adequacy and provider directory policy updates that emerged between December 2023 and February 2024.  Federal Policy Updates CMS Issues Request for Information on Medicare Advantage Data The Centers for Medicare & Medicaid Services (CMS) opened the year with […]

CMS Corrective Action Plans: What Medicare Advantage Organizations Need to Know

CMS Gets Tough on Provider Directories MAOs Be Prepared

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 Organizations (MAOs) that aren’t playing by the rules. We’re breaking down the latest news about the added provider directory requirements and Corrective […]

CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations

Network Adequacy Rules Medicare Advantage Organization Application Credit and Letters of Intent

If you’re involved with compliance, market expansion, or provider recruitment for a Medicare Advantage Organization (MAO), listen up! The Centers for Medicare & Medicaid Services (CMS) tightened its network adequacy oversight, and it’s crucial to understand how this change will impact you and how to navigate the new requirements to ensure compliance. Let’s break it […]

QHP Certification and Network Adequacy Review Timeline

Key Dates PY2025 Qualified Health Plan (QHP) Data Submission and Certification Timeline. Download the calendar now!

Your Cheat Sheet to Key QHP Data Submission and Certification Dates Love a good cheat sheet? So do we! If you’re applying to offer a Qualified Health Plan (QHP) on the Exchanges, we have some excellent news for you. We’ve created a handy calendar to highlight exactly what you need – all the important data submission […]

Network Adequacy and Provider Directory Accuracy Policy Updates

Health Policy News Discover the latest federal and state network adequacy and provider directory accuracy policy developments. Read the blog now!

What’s the latest news on network adequacy and provider directory accuracy? Here’s what took place in November. Download Article Federal Policy Updates Proposed Rule: 2025 Medicare Advantage Program New Mental Health Facility-Specialty Type and Network Adequacy Exceptions The Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Advantage program for the contract […]

Network Adequacy and Provider Directory Accuracy Policy Updates

Health Policy News Discover the latest federal and state network adequacy and provider directory accuracy policy developments. Read the blog now!

Looking for the latest updates on network adequacy and provider directory health policies? You’ve come to the right place. Let’s dive into the latest federal and state policy developments.  Download Article Federal Policy Updates Regulators and policymakers are dedicated to strengthening the oversight process for Medicare Advantage, Marketplace, and Medicaid Health Plans, both at the […]

Efficiency on Autopilot: Volume Provider Network Reports and Analytics

Discover how automated and volume provider network analytics and reports can revolutionize your provider network management processes.

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 […]