Medicare Advantage Network Applications: What You Need to Know for CY 2027
If you’re gearing up for the Contract Year (CY) 2027 Medicare Advantage (MA) application process, this is your guide. Whether it’s understanding key dates, staying ahead of new network adequacy standards, or perfecting your submission, we’ve got insights to help you succeed. Let’s dive in and make sure you’re fully prepared. Key CY 2027 Application […]
Why Enterprise Provider Data Management is Important for Health Plans
Managing provider data presents an incredible opportunity to embrace innovation and drive meaningful change. As expectations for speed, accuracy, and adaptability continue to rise, organizations have the chance to reimagine how provider databases are updated, network analysis is integrated, and statuses are validated more frequently than ever. The shift away from manual, labor-intensive processes is […]
Top Trends For Provider Data Management
Effective provider data management is essential to meeting organizational, regulatory, and member experience expectations. To help address growing demands, we’ve outlined several emerging Provider Data Management trends that can help streamline processes and offer meaningful improvements to overall data management practices. Provider Data Management Trend #1:Strategic Alignment of Management Plans Developing comprehensive plans that align your provider data management activities with broader […]
No Surprises Act: Protecting Patients and Improving Provider Directory Accuracy
When patients search for care, they rely on provider directories to guide them to the right clinician, without the risk of unexpected bills. Out-of-date directories can put patients at financial risk and create compliance challenges for health plans and providers. The federal No Surprises Act, enacted in January 2022, addresses these risks by establishing nationwide […]
The Latest Medicare Advantage Provider Directory Requirements
Provider directory accuracy is essential for improving access to healthcare services for Medicare Advantage (MA) beneficiaries. According to the Centers for Medicare & Medicaid Services (CMS), “Provider directories are an important tool MA enrollees use to select and contact their physicians and other contracted providers who deliver medical care. Beneficiaries and their caregivers rely on […]
What Is Provider Data Validation and Why It Matters for Health Plans
When was the last time you relied on your provider network data? Was it to prepare for a regulatory submission? Evaluate network performance? Update provider directories? Or maybe to decide whether to continue offering a specific product? No matter the reason, one factor was likely central to your outcome: provider data accuracy. Accurate and up-to-date […]
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 […]
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 […]
How to Increase Practitioner Engagement for Data Verification
Provider data accuracy is the cornerstone of outstanding patient care, streamlined operations, and regulatory compliance. Despite its critical importance, the healthcare industry often encounters a formidable obstacle: obtaining timely responses from practitioners for data verification. Busy schedules, administrative overloads, and the sheer complexity of data management often result in delayed responses from practitioners. Overcoming this […]
Key Provider Outreach and Verification Metrics for Successful Provider Directory Audits
If you want to pass a provider directory audit, looking at your provider outreach analytics is a great place to start. With the right analytics, you can demonstrate compliance and improve provider data accuracy. In this article, we’ll walk you through the must-have metrics to help you stay on the right side of compliance and […]
