Tips to Avoid the Ghost Network Trap

Understanding which doctor or specialist is in-network should be pretty straightforward. But often, that’s not the case. Health, dental, vision and other insurance databases frequently contain outdated information. As a result, it appears that there are more practitioners, specialists, and other healthcare professionals in-network and available to see patients than actually exist. This becomes a […]

How Ghost Networks Impact Health Plans and Health Systems

5 WAYS GHOST NETWORKS HARM YOUR PROVIDER NETWORK Disrupts access to patient care. Creates a distorted view of capacity in service lines and the provider network. Causes unintended misrepresentation of the provider network. Diminishes the competitive advantage of the provider network. Exhausts time and money to recruit new, best-fit providers.   Watch the video below […]

Quest Analytics Introduces Network Performance Services

Quest Analytics Introduces Network Performance Services

OVERLAND PARK, KS (November 15, 2022) – Quest Analytics, the leader in provider network management solutions and services, today introduced Network Performance Services, a new offering that helps optimize provider networks with in-depth performance analytics, competitive network benchmarking and provider claims activity. Through automated tools and available expert consultants, Network Performance Services provides clients with critical […]

The Hottest Trends Across Health Insurance Markets

EVOLVING HEALTHCARE POLICY LANDSCAPE FOR NETWORK ADEQUACY Regulators and policymakers continue to make changes that strengthen federal and state oversight process for Medicare Advantage, Marketplace, and Medicaid Health Plans. Let’s look at what’s happening in each market. Medicare Advantage: Network Adequacy Requirements for Applications In a previous blog post, we discussed how the Centers for Medicare […]

Federal Medicaid Network Adequacy Standards

BASIC MCO QUANTITATIVE NETWORK ADEQUACY STANDARDS OVERVIEW This Basic Overview is an overview of what is required of States under current federal regulations.3 At a minimum, a State must develop a quantitative network adequacy standard for the following provider types, if covered under the MCO contract: Primary care, adult and pediatric OB/GYN Behavioral health (mental health and […]

Consideration for Health Equity Measures in Network Adequacy Standards

The Affordable Care Act (ACA) directed the Centers for Medicare & Medicaid Services (CMS) to establish rules to require that Exchange health plans ensure a sufficient choice of providers.1 To implement this requirement, CMS adopted quantitative standards, which require Exchange health plans to ensure that its network providers are available to members within specified time and […]

Improving Network Adequacy and Access For Mental Health

Federal and state policymakers are taking a variety of measures to improve access to mental health services and substance use disorder treatments. Network adequacy and access are prominent areas of such a response directly affecting health plans. This blog post informs stakeholders about the increased emphasis on behavioral health networks and tips on how to […]

CMS to Regulate Qualified Health Plan (QHP) Network Adequacy

Starting Plan Year 2023, the Centers for Medicare & Medicaid Services (CMS) is responsible for imposing the regulations for the Qualified Health Plan (QHP) certification process, including network adequacy standards and reviews. This change was affirmed in the second final rule, HHS Notice of Benefit and Payment Parameters (also known as “2022 Payment Notice”). Specifically, changing […]

Key Application Dates: Unpacking The CMS Medicare Advantage Calendar

Centers of Medicare & Medicaid Services (CMS) Key Application Dates for CY 2022 Medicare Parts C and D Annual Calendar Our CMS calendar is one of the easiest ways to stay up-to-date with important dates and timelines for CY 2022 Medicare Advantage (MA) plans, Medicare Advantage-Prescription Drug (MA-PD) plans, Prescription Drug Plans (PDPs), Medicare-Medicaid Plans […]

Top 3 Things the “No Surprises Act” Means for Health Plans

It’s staggering to think that, according to researchers, one in five emergency room visits result in an individual receiving a bill for treatment or services they expected to be covered by their health plan, but weren’t. These unexpected, costly, and often frustrating charges are aptly called Surprise Medical Bills. While surprise medical bills impact consumers financially, […]