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, […]

Designing and Building Clinician Networks That Address Social Determinants of Health

FIVE TAKEAWAYS FROM OUR WEBINAR Watch: Designing and Building Clinician Networks That Address Social Determinants of Health As clinicians and payers take on increasing risk for patient outcomes, it is essential that leaders consider the effectiveness of their networks as well as the accuracy of their clinician directories to ensure they are adequately serving their members. Modern […]

5 Things I Learned at Vision Quest

5 Things I Learned at Vision Quest

Admittedly, I’m new to provider network management. I’ve spent years working in healthcare, but this is my first time working with payers from across the nation to improve the access, adequacy, and accuracy of their provider networks. Lucky for me, I got a behind-the-scenes view through Quest Analytics Vision Quest. As a session moderator, I heard […]

Preparing for the Era of Provider Network Transparency

Copyright 2020 Compliance Today, a publication of the Health Care Compliance Association (HCCA). Transparency is one of the top buzzwords in healthcare today. In the last few years, we have seen the rollout of significant healthcare transparency initiatives focused on portable health records, hospital costs, drug costs, quality data, and many other things (e.g., Executive […]

Rule Raises Questions About Telehealth, Directory Accuracy

Reprinted with AIS Health permission from the July 2, 2020, issue of  RADAR on Medicare Advantage. As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 […]

Quest Analytics Launches Quest Enterprise Services

Quest Analytics Launches Quest Enterprise Services

First to launch platform enabling health plans to simultaneously measure, manage and monitor network adequacy AND directory accuracy. OVERLAND PARK, Kan., June 16, 2020 – Quest Analytics, the leader in measuring, managing and monitoring health plan network performance, today announced the release of Quest Enterprise Services (QES), the first and only platform to enable the health plan community to […]

Health Plan Best Practices to Comply with SB-137

Health Plan Best Practices to Comply with SB-137

When we say the strictest provider compliance law in the country, we’re not kidding. Although other state and federal regulators, the Centers for Medicare & Medicaid Services (CMS) for example, are starting to incorporate rules around provider directory data, SB-137 requires health plans to reach out to all contracted providers on a quarterly basis to […]

The Health 202: Trump Administration Lets Medicare Plans Off the Hook

Reprinted from the December 4, 2018, article in The Washington Post  THE PROGNOSIS The Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence the conservative-led Centers for Medicare and Medicaid Services is showing special favor to the alternative program over traditional Medicare offerings. In an audit quietly released late […]

Medicare Advantage Provider Directories Are Still Systemically Inaccurate

Reprinted from December 4, 2018, article in Modern Healthcare Federal audits of Medicare Advantage plans’ provider directories have revealed sweeping inaccuracies for the third straight year, raising the specter of fines or other penalties for the insurers. Nearly 50% of provider directory locations showed at least one mistake in the latest audit results, the CMS said […]