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 […]
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 […]
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, […]
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 […]
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 […]
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 […]
