How Ghost Networks Impact Health Plans and Health Systems
Health plans and health systems face significant financial challenges due to the presence of ghost providers. Keeping these providers in your data undermines the efficacy of health systems, resulting in both direct and indirect financial implications. Understanding the hidden costs and addressing them is paramount for maintaining operational excellence and financial stability. 5 Ways Ghost […]
CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations
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. CMS Network Adequacy Reviews for Initial […]
The Hidden Costs of Not Having Accurate Provider Data & How to Solve It
You’ve probably heard the buzz surrounding provider data accuracy, and you might be wondering just how important it is for your organization. Well, you’re not alone! We conducted a study to uncover the hidden costs of not having accurate provider data. Buckle up, because we’re about to share some eye-opening insights with you. Download the […]
Network Adequacy and Provider Directory Accuracy Policy Updates
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
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 […]
How to Increase Practitioner Response Rates for Data Accuracy
Identifying effective strategies to engage healthcare practitioners is crucial for insurers and decision-makers. By improving response rates from practitioners, you can gather valuable insights and enhance your decision-making processes. In this blog, we will explore three proven strategies that can help you increase practitioner engagement and boost your practitioner response rates. https://youtu.be/gdetAGKa2wk?si=LZLCjBylPVD5U41j How to Simplify […]
Key Metrics for Provider Directory Audits: Provider Outreach Analytics
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 […]
FAQs: Medicare Advantage Applications and Letters of Intent
Medicare Advantage Organizations applying for initial, or service area expansion can use Letters of Intent in place of a signed contract to help meet network adequacy requirements while going through the application process. The intention is to give applicants seeking to expand into a new market the opportunity to reach the threshold for network adequacy […]
5 Best Practices: Improving Provider Data Accuracy, Provider Outreach and Outcomes
Everyone’s buzzing about improving provider data accuracy and transparency these days—and for good reason. Just like an athlete training to reach peak performance, healthcare professionals like yourself need the right strategy and tools to succeed. In this article, we’ll dive into five best practices for improving provider data accuracy and outreach to achieve better outcomes. […]
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 […]
