What is Provider Data Validation – Are You in Compliance?
What is Provider Data Validation? Provider data validation – also known as provider data verification or attestation – is a process where health plans confirm that information listed for healthcare providers is current, correct, and complete. Provider data validation helps ensure key information about the practitioner is accurate. This information can include: Digital Contact Information […]
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 […]
QHP Certification and Network Adequacy Review Timeline
Who doesn’t love a good calendar? We know we do. Whether you’re deep into network adequacy updates or juggling deadlines left and right, we’ve got your back. Our handy calendar lays out the crucial submission dates for Qualified Health Plan (QHP) issuers on Federally-facilitated Exchanges. As a bonus, we’ll keep it updated for you! Go ahead and […]
The Requiring Enhanced & Accurate Lists of Health Providers Act
Are enrollees receiving the healthcare services they were promised? Inaccurate provider directories and ghost networks have been longstanding concerns in the healthcare industry, particularly with mental health services. Recognizing the need for improvement, lawmakers have proposed new legislation to address inaccurate data and help seniors receive the care they purchased. The Requiring Enhanced and Accurate Lists […]
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 […]
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 […]
What You Need to Know About QHP Certification
Staying on top of all the latest updates in the industry can be a real challenge. That’s why we’re here to break down everything you need to know about the Qualified Health Plan (QHP) certification network adequacy requirements for plan year 2026. QHP Application and Network Adequacy Requirements Every year, the Department of Health and […]
Four Ways Regulators Prioritize Health Equity into Network Adequacy
In the pursuit of high-quality healthcare, it is essential to go beyond network adequacy metrics and prioritize health equity. In a conversation between Scott Westover, SVP of Network and Regulatory Strategy at Quest Analytics, Michael Conway, Colorado Insurance Commissioner, and Grace Arnold, Minnesota Department of Commerce Commissioner, we learned how these leaders are working together […]
CMS Request For Information on Strengthening Medicare Advantage
RESOURCE CENTER FOR HEALTH PLAN REGULATORS AND POLICYMAKERS Welcome to a space designed for federal and state regulators, insurance commissioners, and health policymakers at all levels to drive conversations around ensuring timely and appropriate access to care. Join our conversations!
New Features to Improve Compliance with Federal Regulations
OVERLAND PARK, KS (June 30, 2022) – Quest Analytics, the leader in provider network management solutions and services, today introduced three new features for Quest Enterprise ServicesTM (QES) designed to improve their client’s ability to address the No Surprises Act (NSA), QHP Certification and the evolving provider network regulations. The new offerings include: Accuracy API & Daily Refresh: With the No Surprises Act […]
